RT Journal Article
SR Electronic
T1 Improved Survival for an Integrated System of Reduced Intensive Respiratory Care for Patients Requiring Prolonged Mechanical Ventilation
JF Respiratory Care
FD American Association for Respiratory Care
SP 517
OP 524
DO 10.4187/respcare.01530
VO 58
IS 3
A1 Ming-Shian Lin
A1 Yuan-Horng Yan
A1 Jung-Der Wang
A1 Hsin-Ming Lu
A1 Likwang Chen
A1 Mei-Chuan Hung
A1 Po-Sheng Fan
A1 Cheng-Ren Chen
YR 2013
UL http://rc.rcjournal.com/content/58/3/517.abstract
AB 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.