Mechanical ventilation in rural ICUs

Abstract

Background:In recent years, rural hospitals have expanded their scope of specialized services, which has led to the development and staffing of rural intensive care units (ICUs). There is little information about the breadth, quality or outcomes of these services. This is particularly true for specialized ICU services such as mechanical ventilation, where little, if any, information exists specifically for rural hospitals. The long-term objectives of this project were to evaluate the quality of medical care provided to mechanically ventilated patients in rural ICUs and to improve patient care through an educational intervention. This paper reports baseline data on patient and hospital characteristics for both rural and rural referral hospitals.Results: Twenty Iowa hospitals were evaluated. Data collected on 224 patients demonstrated a mean age of 70 years and a mean ICU admission Acute Physiology and Chronic Health Evaluation (APACHE) II score of 22, with an associated 36% mortality. Mean length of ICU stay was 10 days, with 7.7 ventilated days. Significant differences were found in both institutional and patient variables between rural referral hospitals and rural hospitals with more limited resources. A subgroup of patients with diagnoses associated with complex ventilation had higher mortality rates than patients without these conditions. Patients who developed nosocomial events had longer mean ventilator and ICU days than patients without nosocomial events. This study also found ICU practices that frequently fell outside the guidelines recommended by a task force describing minimum standards of care for critically ill patients with acute respiratory failure on mechanical ventilation.Conclusions: Despite distinct differences in the available resources between rural referral and rural hospitals, overall mortality rates of ventilated patients are similar. Considering the higher mortality rates observed in patients with complicated medical conditions requiring complex ventilation management, the data may suggest that this subgroup could benefit from treatment at a tertiary center with greater resources and technology.

Epidemiology of mechanically ventilated patients treated in ICU and non-ICU settings in Japan: a retrospective database study

“…However, even for patients treated in the ICU, the management and outcomes may differ among institutions. In the USA, a comparison between patients on MV treated in rural hospitals with relatively limited resources and those treated in referral hospitals with better resources identified higher mortality rates in rural hospitals [ 16 ]. Also in Japan, ICUs certified by academic societies have better patient outcomes than those not certified [ 17 ].…”

Trend Analysis and Outcome Prediction in Mechanically Ventilated Patients: A Nationwide Population-Based Study in Taiwan

“…Annual increases in the prevalence of MV patients were observed during 2004–2009. The data also confirmed previous reports that MV treatment outcomes are associated with the following: age, gender, CCI score, teaching hospital, hospital level, hospital volume, physician volume, infectious and parasitic diseases, tumor, endocrine, nutritional, or metabolic diseases or immunity disorders, mental system and sensory organ diseases, circulatory system diseases, digestive system diseases, genitourinary system diseases, skin and subcutaneous tissue disorders, symptoms: signs and unexplained, and injury and poisoning [ 3 , 7 , 8 , 11 – 13 ]. Our findings highlight the continuing need for efforts to increase the efficiency of medical resource utilization, to improve clinical outcomes in this population, and to provide renewed justification for prioritizing acute respiratory failure and MV in national research and policy initiatives.…”

“…The assessment was limited to patients who had received ventilation for longer than 96 hours [ 7 ]. The purposes of this criterion were to limit the analysis to patients with treatment times sufficiently long to evaluate overall patient care management techniques and practice patterns and to increase the homogeneity of the studied patient population among different facilities and over time [ 8 ]. After excluding data for patients aged younger than 18 years and patients with continuous MV shorter than 96 consecutive hours (n = 417,400 subjects), the final dataset included data for 213,945 MV patients treated from 2004 to 2009.…”

The Experience and the Characteristics of Patients With Tele-ICU Implementation in a Rural Community Hospital

“…In Japan, the rate of ICU beds versus general beds is very low [ 4 ]. Therefore, many critically ill patients are treated in general wards and rural community hospitals [ 5 , 6 ]. In addition, the shortage of critical care physicians and emergency physicians poses a problem in small rural hospitals in Japan [ 7 ].…”