PURPOSE: A growing body of evidence suggests that the quality of care in the Intensive Care Unit (ICU) is strongly influenced by availability of intensivists 24/7. High intensity of staffing is associated with a 40% decrease in ICU mortality. There is paucity in literature of ventilator outcomes in ICU's staffed 24/7 by intensivists. The purpose of the study was to determine the outcomes of ventilated patients in our MICU.
METHODS: All mechanically ventilated patients admitted to the MICU from January 2005 to December 2006 were included in the study. MICU database was analyzed and charts reviewed.
RESULTS: A total of 2486 patients were admitted to the ICU from January 2005 to December 2006. Of these 1163 (47%) were mechanically ventilated. 811 (70%) were successfully extubated with an average of 3.6 ventilator days. The hospital mortality for ventilated patients was 19% with an overall mortality for ICU admissions of 9%. 127 patients (11%) were transferred out to the Ventilator unit either as poor prognosis or need for long-term ventilation. Of these patients 54% were transferred for Long term Ventilaory support, 30% died and 11% were successfully liberated from mechanical ventilation. The self-extubations for all patients on Ventilator was 5% and reintubation rates after planned extubation was 4%.
CONCLUSION: Staffing of the ICU with dedicated Intensivists resulted in successful extubations in 87 % of all survivors. The re-intubation rates ( in 96 hours) was 4% and self-extubation rate was 5%.Of the patients transferred as poor prognosis or need for long term mechanical ventilation, 89 % either died or were transferred to a Long Term Ventilator Facility. 24/7 coverage by Intensivists resulted in superior outcomes in mechanically ventilated patients. To the best of our knowledge, this is the first study which has studied the outcomes of mechanically ventilated patients in ICU staffed 24/7 by intensivists over a 2 year period.
CLINICAL IMPLICATIONS: 24/7 Intensivist staffing in a closed ICU results in superior outcomes in patients mechanically ventilated. This validates Leap Frog Initiatives.
DISCLOSURE: Sindhaghatta Venkatram, No Financial Disclosure Information; No Product/Research Disclosure Information