Mechanically Assisted Ventilation in a Community Hospital

Witek, Theodore J.; Schachter, E. Neil; Dean, Norman L.; Beck, Gerald J.

doi:10.1001/archinte.1985.00360020055010

Cited by 47 publications

(8 citation statements)

References 10 publications

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“…Their average intubation time was 6 d, with a mean time to reintubation of 2 d. This group had a 60% incidence of new pulmonary infiltrates and a 10% mortality. Others have found reintubation rates of 4 to 19% (9,22). As in the present study, standard criteria for the adequacy of spontaneous ventilation and gas exchange have been poor predictors of the need for reintubation (16).…”

Section: Discussionsupporting

confidence: 55%

“…Extubation, when unlikely to be successful, may increase morbidity (9,11,22,23), although several studies have found that premature extubation, after which urgent reintubation is required, may not necessarily increase mortality. A previous retrospective study from our institution found no increase in pneumonia after earlier extubation in patients with TBI (11).…”

Section: Discussionmentioning

confidence: 99%

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Implications of Extubation Delay in Brain-Injured Patients Meeting Standard Weaning Criteria

Coplin

Pierson

Cooley

et al. 2000

Am J Respir Crit Care Med

426

303

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We hypothesized that variation in extubating brain injured patients would affect the incidence of nosocomial pneumonia, length of stay, and hospital charges. In a prospective cohort of consecutive, intubated brain-injured patients, we evaluated daily: intubation status, spontaneous ventilatory parameters, gas exchange, neurologic status, and specific outcomes listed above. Of 136 patients, 99 (73%) were extubated within 48 h of meeting defined readiness criteria. The other 37 patients (27%) remained intubated for a median 3 d (range, 2 to 19). Patients with delayed extubation developed more pneumonias (38 versus 21%, p < 0.05) and had longer intensive care unit (median, 8.6 versus 3.8 d; p < 0.001) and hospital (median, 19.9 versus 13.2 d; p = 0.009) stays. Practice variation existed after stratifying for differences in Glasgow Coma Scale scores (10 versus 7, p < 0.001) at time of meeting readiness criteria, particularly for comatose patients. There was a similar reintubation rate. Median hospital charges were $29,057.00 higher for extubation delay patients (p < 0.001). This study does not support delaying extubating patients when impaired neurologic status is the only concern prolonging intubation. A randomized trial of extubation at the time brain-injured patients fulfill standard weaning criteria is justifiable.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Implications of Extubation Delay in Brain-Injured Patients Meeting Standard Weaning Criteria

Coplin

Pierson

Cooley

et al. 2000

Am J Respir Crit Care Med

426

303

View full text Add to dashboard Cite

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“…The most common difficulty was making a distinction in patients with multiple reasons for respiratory failure between a specific diagnosis and the &dquo;other&dquo; category. Our classification of diagnosis is similar to ones that have been described in other overview studies of respiratory failure; all diagnostic categories except asthma and ARDS are mentiod at least once by other authors [5,8,9,11]. We believe that these diagnostic classifications are meaningful, and the different survival rates of the diagnostic groups as well as the similarity to survival in published series strengthens this belief (see Table 2).…”

Section: Discussionsupporting

confidence: 84%

“…Previous overview studies of patients treated with mechanical ventilation have come from observations in mixed medical-surgical intensive care units [1,5,8,9,11,14]; these patient care areas are separate in our hospital. Pediatric patients were excluded from the study because they are triaged to one of the other hospitals in the community; thus none of the patients were younger than 15 years.…”

Section: Discussionmentioning

confidence: 99%

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Mechanical Ventilation: Analysis of Increasing Use and Patient Survival

Swinburne

Fedullo

Shayne

1988

J Intensive Care Med

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Swinburne AJ, Fedullo AJ, Shayne DS. Mechanical ventilation: analysis of increasing use and patient survival. J Intensive Care Med 1988;3:315-320.To quantitate and assess an increase in the use of mechanical ventilation, we retrospectively analyzed the records of 1,589 patients treated with mechanical ventilation. Between 1974 and 1983, there was a 156% increase in the number of patients treated each year.There were significant increases in the number of patients with cardiac pulmonary edema (p < 0.001), adult respiratory distress syndrome (p < 0.01), chronic obstructive lung disease (p < 0.005), neuromuscular disease (p < 0.025), and cardiopulmonary arrest (p < 0.005). Regression analysis versus time shows that older patients (p < 0.025) and more chronically ill patients (p < 0.05) are now being treated with mechanical ventilation. Overall survival was 41.4%, and yearly survival rates remained constant during the ten-year period. Survival was 55.3% for patients with cardiogenic pulmonary edema, 34.1 % for the adult respiratory distress syndrome, 65.7% for chronic obstructive lung disease, 90.5% for asthma, 38.7% for neuromuscular disease, 92.1% for drug overdose, 33.7% for pneumonia, and 19.1 % for cardiopulmonary arrest. Studies are needed that will determine predictors of survival from acute respiratory failure for patients with chronic heart and lung disease. Such predictors will help physicians counsel their patients when making the decision to be treated with mechanical ventilation in the event of respiratory failure.Mechanical ventilation saves many lives by making recovery from respiratory failure possible. It is also a costly therapy [1] ] that may sustain life when recovery can no longer occur [2]. As pressures mount to limit the costs of medical care and concerns increase about prolonging life in the hopelessly ill, careful scrutiny of the use of mechanical ventilation becomes increasingly important.Since 1980, Rochester, NY, hospitals have been funded by an experimental prospective reimbursement system based on 1978 costs [3]. Budgetary restrictions imposed by this system made it difficult for our hospital to allocate funds for the personnel and equipment needed to care for an increasing number of patients requiring mechanical ventilation. This focused our attention on the issue of increased use of mechanical ventilation. Several explanations for this increase were proposed, including a change in diagnostic case mix and more aggressive use of mechanical ventilation in the treatment of aged or chronically ill patients.To quantitate the increase and to test our hypotheses about case mix changes and changing physician practice patterns, we reviewed the medical records of all patients treated with mechanical ven-

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