Daily cost of an intensive care unit day: The contribution of mechanical ventilation*

Dasta, Joseph F.; McLaughlin, Trent; Mody, Samir H.; Piech, Catherine Tak

doi:10.1097/01.ccm.0000164543.14619.00

Cited by 739 publications

(585 citation statements)

References 19 publications

(13 reference statements)

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“…The number of patients receiving prolonged MV in the United States exceeds more than 300,000 each year in the intensive care unit (ICU) (20). Although MV can be a lifesaving measure, prolonged MV results in the rapid development of diaphragmatic weakness due to both atrophy and contractile dysfunction.…”

mentioning

confidence: 99%

Ventilator-induced diaphragm dysfunction: cause and effect

Powers

Wiggs

Sollanek

et al. 2013

American Journal of Physiology-Regulatory, Integrative and Comp

140

156

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Powers SK, Wiggs MP, Sollanek KJ, Smuder AJ. Ventilator-induced diaphragm dysfunction: cause and effect. Am J Physiol Regul Integr Comp Physiol 305: R464 -R477, 2013. First published July 10, 2013 doi:10.1152/ajpregu.00231.2013 is used clinically to maintain gas exchange in patients that require assistance in maintaining adequate alveolar ventilation. Common indications for MV include respiratory failure, heart failure, drug overdose, and surgery. Although MV can be a life-saving intervention for patients suffering from respiratory failure, prolonged MV can promote diaphragmatic atrophy and contractile dysfunction, which is referred to as ventilator-induced diaphragm dysfunction (VIDD). This is significant because VIDD is thought to contribute to problems in weaning patients from the ventilator. Extended time on the ventilator increases health care costs and greatly increases patient morbidity and mortality. Research reveals that only 18 -24 h of MV is sufficient to develop VIDD in both laboratory animals and humans. Studies using animal models reveal that MV-induced diaphragmatic atrophy occurs due to increased diaphragmatic protein breakdown and decreased protein synthesis. Recent investigations have identified calpain, caspase-3, autophagy, and the ubiquitin-proteasome system as key proteases that participate in MV-induced diaphragmatic proteolysis. The challenge for the future is to define the MV-induced signaling pathways that promote the loss of diaphragm protein and depress diaphragm contractility. Indeed, forthcoming studies that delineate the signaling mechanisms responsible for VIDD will provide the knowledge necessary for the development of a pharmacological approach that can prevent VIDD and reduce the incidence of weaning problems. respiratory muscle; atrophy; mechanical ventilation; weaning; muscle wasting MECHANICAL VENTILATION (MV) is used clinically to achieve sufficient pulmonary gas exchange in patients unable to sustain adequate alveolar ventilation on their own. Common indications for MV include respiratory failure due to chronic obstructive pulmonary disease, status asthmaticus, and/or heart failure. In addition, MV is often an essential intervention in patients suffering from acute drug overdose, neuromuscular diseases, sepsis, and during surgery along with postsurgical recovery.The number of patients receiving prolonged MV in the United States exceeds more than 300,000 each year in the intensive care unit (ICU) (20). Although MV can be a lifesaving measure, prolonged MV results in the rapid development of diaphragmatic weakness due to both atrophy and contractile dysfunction. This detrimental impact of prolonged MV on the diaphragm has been termed ventilator-induced diaphragmatic dysfunction (VIDD) and VIDD is predicted to be a major contributor to problems in weaning patients from the ventilator (26, 114). Although previous reports describing the impact of prolonged MV on the diaphragm have appeared in the literature, advances in our understanding of the mechanisms responsible for VIDD h...

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mentioning

confidence: 99%

Ventilator-induced diaphragm dysfunction: cause and effect

Powers

Wiggs

Sollanek

et al. 2013

American Journal of Physiology-Regulatory, Integrative and Comp

140

156

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“…However, we used various measures of resource utilization as a proxy for costs. With the estimated costs of an inpatient day at USD 1236, an ICU day at USD 2278 to USD 5973, and a day on mechanical ventilation at USD 10,299 [13,15], the results presented in the current study represent significant differences between subpopulations of DRG 536. An additional limitation of our study is the inability to identify patients with major complications or comorbidities, who might be classified in DRG 535 (fractures of the hip or pelvis with major complications or comorbidities) based on the ICD-9 diagnosis data given in the National Trauma Data Bank.…”

Section: Discussionmentioning

confidence: 75%

Variation in Resource Utilization for Patients With Hip and Pelvic Fractures Despite Equal Medicare Reimbursement

Samuel

Webb

Lukasiewicz

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Medicare currently reimburses hospitals for inpatient admissions with ''bundled'' payments based on patient Diagnosis-related Groups (DRGs) regardless of true hospital costs. At present, DRG 536 (fractures of the hip and pelvis) includes a broad spectrum of patients with orthopaedic trauma, likely with varying inpatient resource utilization. With the growing incidence of fractures in the elderly, inadequate reimbursements from Medicare for certain patients with DRG 536 may lead to growing financial strain on healthcare institutions caring for these patients with higher costs. Questions/purposes The purposes of the study were to determine whether (1) inpatient length of stay; (2) intensive care unit stay; and (3) ventilator time differ among subpopulations with Medicare DRG 536. Methods A total of 56,683 patients, 65 years or older, with fractures of the hip or pelvis were identified in the 2011 and 2012 National Trauma Data Bank. This clinical registry contains data on trauma cases from more than 900 participating trauma centers, allowing analysis of resource One of the authors certifies that he (AMS) or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Orthopaedic Trauma Association (Rosemont, IL). One of the authors certifies that he (JML) or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Bone Therapeutics (Charleroi, Belgium), an amount of less than USD 10,000 from Kuros (Zurich,Switzerland), an amount of less than USD 10,000 from ISTO Technologies (St Louis, MO, USA), an amount of less than USD 10,000 from Emcyte (Fort Myers, FL, USA), an amount of less than USD 10,000 from Royal Marketing Inc (Westmount, Quebec, Canada), an amount of less than USD 10,000 from Graftys (Chicago, IL, USA), an amount of USD 100,000-USD 1,000,000 from Merck (Kenilworth, NJ, USA), and an amount of USD 100,000-USD 1,000,000 from National Institutes of Health (Bethesda, MD, USA). One of the authors certifies that he (JNG) or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000 from Bioventus (Durham, NC, USA), an amount of USD 10,000-USD 100,000 from Harvard Clinical Research Institute (Boston, MA, USA), an amount of USD 10,000-USD 100,000 from ISTO Technologies (St Louis, MO, USA), an amount of less than USD 10,000 from Medtronic (Minneapolis, MN, USA), an amount of USD 10,000-USD 100,000 from Stryker (Kalamazoo, MI, USA), an amount of less than USD 10,000 from Affinergy (Durham, NC, USA), an amount of USD 10,000-USD 100,000 from Alphatec (Carlsbad, CA), an amount of less than USD 10,000 from DePuy (Raynham, MA, USA), an amount of less than USD 10,000 from Powered Research (Research Triangle Park, NC, USA), an amount of less than USD 10,000 from KCI (San Antonio, TX, USA), an amount of less than USD 10,000...

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“…Life support technology accounts for approximately 5-10% of acute care bed occupancy 1 and has been identified as a key factor escalating intensive care unit (ICU) costs. 2 Weaning accounts for 41% and 60% of the total ventilatory time in mixed, medicalsurgical ICU populations and in populations with chronic obstructive pulmonary disease (COPD), respectively. 3 Over the past decade, clinical investigations have focused on strategies to limit the duration of ventilation, for example, early identification of patients who are likely to be weaned, [4][5][6] tests of readiness to resume spontaneous breathing trials (SBTs), [7][8][9] and strategies to reduce support in patients who fail a SBT.…”

Section: Résumémentioning

confidence: 99%

Weaning critically ill adults from invasive mechanical ventilation: a national survey

Burns

Lellouche²,

Slutsky

et al. 2009

Can J Anesth/J Can Anesth

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Purpose To determine the stated practices of clinicians in weaning critically ill adults from invasive ventilation. Methods We conducted a cross-sectional, self-administered postal survey of Critical Care physicians and respiratory therapists (RTs) in leadership roles at Canadian teaching hospitals. We identified respondents using electronic mail and telephone correspondence. We used rigorous survey methodology to develop, test, and administer the questionnaire.Results One hundred ten of 162 (67.9%) clinicians returned the survey with 99 respondents (55 physicians and 44 RTs) completing it either in-part or in-full. Approximately 95% of respondents acknowledged ever performing spontaneous breathing trials (SBTs) in clinical practice. Of these, 95.6% and 32% of respondents reported conducting daily and twice-daily screening to identify SBT candidates, at least sometimes. The three most common techniques to conduct SBTs included; pressure support (PS) with positive end-expiratory pressure (70.8%), continuous positive airway pressure (35.7%), and use of a T-piece (25.0%). PS ventilation was the weaning strategy used most frequently before SBTs. Most respondents (57.1%) considered continuous infusion of sedative-hypnotics to be a relative contraindication to tracheal extubation. However, concurrent administration of low dose vasopressors, inotropes, and analgesic boluses, or continuous analgesic infusions were considered acceptable amongst 60.8%, 73.2%, 78.4% -009-9124-8 and 58.8% of respondents, respectively. We did not observe regional variation in whether clinicians ever perform SBTs, the ventilatory modes used prior to an SBT nor in the use of PS and SBTs during the weaning process. Conclusions Pressure support and SBTs are common features of weaning in Canadian teaching hospitals. Compared to the published literature, our survey suggests that weaning practices have evolved over time and that practice variation may be greater on an international level compared to a national level.123 Can J Anesth/J Can Anesth (2009) 56:567-576 DOI 10.1007/s12630 RésuméObjectif De´terminer les pratiques de´clare´es des cliniciens concernant le sevrage des patients adultes gravement malades de la ventilation invasive. Méthode Nous avons re´alise´un sondage transversal, auto-administre´et envoye´par courrier aupre`s des me´decins des soins critiques et des inhalothe´rapeutes occupant des positions de leadership dans les hôpitaux d'enseignement canadiens. Nous avons identifie´les re´pondants a`l'aide de correspondance par courrier e´lectronique et par te´le´phone. Nous avons utilise´une me´thodologie de sondage rigoureuse afin d'e´laborer, de tester et d'administrer le questionnaire. Résultats Sur un total de 162 cliniciens, 110 (67,9%) ont renvoye´le questionnaire; 99 re´pondants (55 me´decins et 44 inhalothe´rapeutes) ont comple´te´le questionnaire en entier ou en partie. Environ 95 % des re´pondants ont reconnu qu'ils re´alisaient des tests de ventilation spontane´e (TVS) dans leur pratique clinique. Parmi ceux-ci, 9...

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Daily cost of an intensive care unit day: The contribution of mechanical ventilation*

Cited by 739 publications

References 19 publications

Ventilator-induced diaphragm dysfunction: cause and effect

Ventilator-induced diaphragm dysfunction: cause and effect

Variation in Resource Utilization for Patients With Hip and Pelvic Fractures Despite Equal Medicare Reimbursement

Weaning critically ill adults from invasive mechanical ventilation: a national survey

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