PURPOSE: Close to 20% of ICU patients require PMV (MV > 21 days). The increase in ICU survival, widespread use of NIV, and development of “weaning” units may have impacted in the number and location of these patients. We conducted this study to determine the number and location of PMV individuals in Massachusetts and compared the results with 2 surveys conducted 20 and 10 years ago.
METHODS: A web based survey, was sent to all (113) respiratory care managers practicing in the acute (ACH), long-term acute (LTACH) and home care (HCC) setting in the state.
RESULTS: The response rate was 53%. Thirty-nine (65%) from ACH, 10 (17%) from LTACH, 8 (13%) from HCC and 3 (5%) from other settings. In Massachusetts there are 18 LTACH and 12 HCC that provide home MV. Therefore, response rates in these categories are 56% and 67% respectively. We counted 982 mechanically ventilated patients, 464 (47%) met criteria for PMV. Seventy-two PMV individuals were in ACH, 171 in LTACH and 221 at home; 20 years trend is shown on Figure 1. Of the 221 patients at home, 69 % had neuromuscular disease, 23% COPD and 8% other. The ages were: <18 years (38%), 18 and 65 years (52%) and > 65 years (10%). Most patients (76%) were ventilated via tracheostomy, 14% via nasal mask and 10% via facemask. The duration of MV was < 18hs/day in 96 % of the patients. Limitations for home discharge: 1. Lack of family support, 2. Lack of reimbursement by insurers for home nursing, 3.Economical limitation.
CONCLUSION: The number of PMV patients in Massachusetts is increasing 7.4 /100.000 population (2.8 in 1983). More patients are cared at home particularly for neuromuscular diagnosis.
CLINICAL IMPLICATIONS: LTACH may have decongested our ICU's and possibly offered a more appropriate setting to train family members as healthcare givers in the home. However, placement at home remains difficult to achieve.
DISCLOSURE: Miguel Divo, No Product/Research Disclosure Information; No Financial Disclosure Information