Chest
Volume 107, Issue 2, February 1995, Pages 494-499
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Clinical Investigations in Critical Care
Outcome of Patients Cared for in a Ventilator-Dependent Unit in a General Hospital

https://doi.org/10.1378/chest.107.2.494Get rights and content

We describe our initial experience with the admission of 129 patients for 132 episodes of ventilator-dependence to a self-contained ventilator-dependent unit (VDU) in a general hospital and present a survival comparison between VDU patients and a historic control population from the same institution. Forty-three patients were screened and denied admission to the VDU because long-term ventilator dependence was not felt to be a probable outcome (56%); they were medically unstable, often requiring electrocardiographic monitoring (19%), they had poor rehabilitation potential because of markedly depressed mental status (13%), or they preferred to be treated closer to their homes (12%). Thirteen (9.8%) of the VDU patients died in the hospital compared to 44 (42%) in the historic control group. After exclusion of patients with multiorgan failure (who made up 26% of the control group) and using a proportional hazard model to adjust for group differences in age and disease class, the difference in hospital mortality remained highly significant (p≤0.01). Ninety-one of the 119 VDU patients (77%) were ultimately able to return home; 16 (13%) continued to use a ventilator intermittently at night; 26 patients (22%) were permanently placed in nursing homes, all off of the ventilator. Overall, 88% of the 119 patients discharged had been liberated from mechanical ventilation. Ninety-seven (82%) and 86 (72%) remain alive 1 and 2 years after discharge, respectively. Some of the survival benefits may be directly attributed to the VDU. Others reflect a change in treatment philosophy, which was nevertheless reinforced by our VDU experience.

Section snippets

Organization of the Ventilator-Dependent Unit

The VDU is a self-contained area in the hospital with a dedicated medical and paramedical staff. A physician, approximately 14 nurses with expertise in and devotion to the care of patients with respiratory diseases, and a lead respiratory therapist are permanently assigned to the VDU. Additional personnel with shared responsibilities for other hospital services include pharmacists, respiratory therapists, physical and occupational therapists, dieticians, and a social worker. The unit takes a

RESULTS

The 67 females and 62 males who were admitted to the VDU had a mean age of 68±12 (SD) years, with a range of 24 to 90 years, and 65±14 years, with a range of 20 to 87 years, respectively. With the exception of two outpatients who accounted for three admissions, all patients had been cared for by other medical or surgical services of Saint Marys Hospital prior to admission to the VDU, although some patients who had been transferred to Saint Marys from other hospitals were already

DISCUSSION

There has never been and probably can never be a concurrent controlled study of patients treated in ventilator-dependent units and intensive care or other acute care hospital units. Therefore, we compared the outcomes of our VDU patients with those of a similar group of patients receiving long-term ventilation in the same hospital during a 29-month period from 1986 to 1988. Our experience with caring for ventilator-dependent patients in a VDU has been very rewarding. This report focuses on

ACKNOWLEDGMENTS

The authors wish to express their appreciation to David Hardy, RRT, VDU lead respiratory therapist, and the dedicated nurses of the VDU for making the VDU a success.

REFERENCES (10)

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Supported by Health Care Financing Administration Demonstration Project Grant 29-P-99424/1.

Revision accepted May 26.

Reprint requests: Dr. Gracey, Mayo Clinic, Rochester, MN 55905

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