Prolonged Mechanical Ventilation in Massachusetts: The 2006 Prevalence Survey

BACKGROUND: Prolonged mechanical ventilation and home ventilation impose unique challenges on patients, families, and the heathcare system. In the absence of a centralized database to track prolonged and home ventilation, there has been a paucity of prevalence studies, and what is known is outdated. We surveyed respiratory care managers working in the state of Massachusetts to estimate the prevalence and locations of prolonged and home ventilation in 2006.

METHODS: We invited 113 respiratory care managers practicing in acute-care hospitals, long-term acute-care facilities (also known as weaning units, step-down units, and long-term-ventilation units), and home-care companies to participate in a Web-based survey. We matched the responses to their respective institutions and analyzed the results according to hospital size, location (urban or suburban), and whether the institution was a teaching institution.

RESULTS: In December of 2006 there were 817 ventilated patients, of whom 460 met the criteria for prolonged ventilation (> 21 d for at least 6 h/d) and 221 met the criteria for home ventilation (ventilation for any period of time at home). Of the 239 patients not at home, 64 were in acute-care hospitals, 175 in long-term acute-care facilities, and 221 at home. The survey response rate was 86% for acute-care hospitals with ≥ 400 beds, 48% for acute-care hospitals with < 400 beds, 65% for long-term acute-care facilities, and 67% for home-care companies. The non-respondents were primarily smaller, suburban, non-teaching hospitals, which have a low prevalence of prolonged-ventilation patients. Among the home-ventilation patients, the majority had neuromuscular diseases, were < 65 years old, and were ventilated via tracheostomy tube. The most important limitations to transitioning prolonged-ventilation patients to home ventilation appeared to be lack of family and/or economic support.

CONCLUSIONS: In Massachusetts, the estimated prevalence of prolonged and home ventilation increased from 2.8/100,000 inhabitants in 1983 to 7.1/100,000 inhabitants in 2006, and the majority of them are in long-term acute-care facilities, large urban teaching hospitals, and at home.