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Respiratory Care |

Experience With Invasive Home Mechanical Ventilation in Indian Patients Discharged From Respiratory Unit

Mir Ali, RPT; Deepak Talwar, DM
Author and Funding Information

Metro Hospital and Heart Institute, Noida, India


Chest. 2014;145(3_MeetingAbstracts):547A. doi:10.1378/chest.1824329
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Abstract

SESSION TITLE: Respiratory Support Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: To evaluate outcome of weaning failure patients sent home on invasive home mechanical ventilation.(IHMV)

METHODS: Overall feasibility,safety,efficacy and cost-effectiveness of 10(n=10) tracheostomised patients unable to wean discharged from Metro Centre for Respiratory Disease on IHMV in the year 2012, were analyzed .Cost-effectiveness was evaluated in terms of cost saved per patient discharged alive, life year saved and cost per year of life saved. The survival was calculated by the 30 days mortality rate. Efficacy was calculated by number of decannulation and discontinuation of IMV. Data was statistically analyzed using χ2 test with level of significance taken at p ≤ 0.05

RESULTS: The mean age of the patient population was 72.1±12.84years.Mean duration of hospitalization was 23.7±12.62 days whereas ICU stay was 11.7±6.01 days. Six patients were sent home on BiPAP (S/T mode) with IPAP of 14.4 ± 1.63 cm H2O and EPAP of 6.11 ± 0.8 cm H2O, whereas 3 patients were sent home on BIPAP with AVAPS and one on SIMV(PC mode).Median days patients were followed up at home were 35.8 days with a median duration of usage of MV being 18.6 days. The 30 days mortality was 40% (p=0.188).Two patients required readmission.The cost saved per patient discharged alive, who either died or were readmitted was US$ 16241.72. The life year saved was 0.13(p= 0.361) whereas the cost-per year of life saved was US$ 151662.18. Three(n= 3)patients (30.0%; p= 0.241) were successfully decannulated and continue on IHMV beyond 30 days, two discontinued HMV.

CONCLUSIONS: Discharging stable failure to wean patients on invasive home mechanical ventilation is an acceptable and cost effective alternative in India . It reduces health care cost to self and providers with acceptable survival rate and effective weaning with decannulation being achieved at home.

CLINICAL IMPLICATIONS: Though India has no hospice care, but failure to wean stable patient can be sent home on IMV with acceptable good outcomes

DISCLOSURE: The following authors have nothing to disclose: Mir Ali, Deepak Talwar

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