Abstract
BACKGROUND: The introduction of reduced respiratory care may lead to worse long-term outcomes for patients undergoing prolonged mechanical ventilation (PMV) for more than 21 days. The objective of this study was to determine the survival for an integrated system of reduced intensive respiratory care (ISRIRC) by the Taiwan Bureau of National Health Insurance, in patients requiring PMV.
METHODS: A 10-year retrospective study was performed in a 1,000-bed teaching hospital in Taiwan. A total of 633 consecutive PMV patients transferred from the hospital between 1998 and 2007 were enrolled. Medical records were reviewed to collect the clinical data, which were linked to the National Death Certification Database to ascertain subject survival. Kaplan-Meier estimates were performed, and a Cox proportional hazards model was constructed. We further conducted a corroboration study and retrieved a systematically randomized nationwide sample of PMV subjects with combined septicemia and shock, and compared the survival functions of those who were treated before and after the integrated system, including 228 and 2,677 subjects, respectively.
RESULTS: The survival rates at 3 months, 6 months, and 1 year were 60.0%, 44.0%, and 30.0%, respectively. The 1-year survival rates of the subjects before and after ISRIRC were 21.0% and 37.2%, respectively (P = .04). The factors associated with better survival were younger age, absence of cirrhosis, and establishment of the ISRIRC. A comparison of the 4-year survival in the larger random sample of PMV subjects with combined septicemia and shock before and after ISRIRC also showed a significant improvement.
CONCLUSIONS: With the improvement of PMV technology in the early 2000s, the establishment of ISRIRC seems to be associated with an improved survival rate for subjects under PMV.
- survival
- respiratory care
- health services
- healthcare delivery
- long-term acute care
- prolonged mechanical ventilation
- elderly patients
Footnotes
- Correspondence: Cheng-Ren Chen MD, Division of Chest Medicine, Department of Internal Medicine, Chia-Yi Christian Hospital, 539 Jhongsiao Road, Chiayi City, Taiwan. E-mail: 01994{at}cych.org.tw.
This work was supported by research grant NSC-98-2314-B-705-001 from the Taiwan National Science Council, and by research grants R97-9 and R98-3 from Chia-Yi Christian Hospital. The interpretations and conclusions reported in this paper do not represent those of the Taiwan Bureau of National Health Insurance, Department of Health, or National Health Research Institutes. The authors have disclosed no conflicts of interest.
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