Patients requiring chronic mechancial ventilation consume an increasing proportion of human and financial resources. Despite increasing focus this problem has continued to escalate nationally. While respiratory patients are commonly thought to account for the greatest proportion of these patients this question has not been well studied.We sought to evaluate the source and epidemiology of chronically mechanically ventilated patients in our 750 bed tertiary teaching facility that serves as a regional cardiac center. All patients requiring MV≥ 10d over a 1 year period were included.
Retrospective review of respiratory therapy quality assurance and APACHE III data for the period Jan. to Dec. 2002. Unit specific long term MV data abstracted from our MICU, SICU, RCU,PICU,NICU and CTU. Long-term MV was defined as a duration of ≥10d.
650 patients were ventilated for ≥ 10 days. While adult patients accounted for the majority, a significant number a pediatric cases, particularly neonatal required MV for ≥ 10 days. The RCU had the highest proportion of total long term MV patients (55%). Surgical units, particularly general surgery accounted for 31% of patients. 9% of all cardiac surgical patients required MV for ≥10d. The NICU and the SICU had the highest absolute number of long term MV patients at 142 and 151 respectively. Of all MICU/SICU patients requiring MV for ≥10 days 35% of ventilator days were greater than 2 weeks and 13% were more than 3 weeks. The mean age for these patients was 71.
Older adult patients account for the majority of chronically MV patients. Post-operative surgical patients are the most frequent source of these patients, with cardiac surgery accounting for a significant minority. Neonatal respiratory failure also results in significant requirements for prolonged life support.IMPLICATIONS: Improved pre-operative evaluation and prevention of post-operative complications like aspiration and VAP may improve outcomes in these patients. Furthermore, evidence based disease specific ventilator management and weaning protocols may be utilized to aid in reducing ventilator duration.
Proportion of Individual Unit Totals: Long-Term MV PatientsRCU55%NICU33%SICU31%PICU26%MICU19%CTU9%
A.A. Quinones, None.