Outcome and costs of intensive care. A follow‐up study on patients requiring prolonged mechanical ventilation

Abstract

This historically prospective study analysed hospital costs and long-term outcome in 249 consecutive patients who required intensive care including intermittent positive pressure ventilation (IPPV) for 48 h or more. The mean age of the patients was 46.7 years and the mean duration on IPPV was 9.1 days. Mortality in hospital was 43%, increasing to 54.6% five years after admission. The mean cost per patient treated was 22,823 US dollars (USD (1980 value]. The mean cost to yield one survivor was 40,035 USD. The mean cost per survivor was 26,056 USD, whereas that of a non-survivor was 18,500 USD. The cost-benefit ratio, i.e. calculated cost per year of extended life until the age of 75 years, averaged 1420 USD (range 360-7980 USD). With the exception of patients suffering from cancerous diseases, the cost-benefit ratio found in this study was favourable in comparison to other high-cost medical care. This is further emphasized by the fact that for the years saved, the quality of life was mostly good.

Early organ dysfunction affects long-term survival in acute pancreatitis patients

“…It is important not to dismiss this finding as obvious, albeit expected, because the observation refers to more than just the fact that older people die sooner from all causes. Although age has been established as an independent predictor in the present and previous studies, it has been suggested that poorer outcomes in elderly patients may reflect residual functional disability and dysfunction of organ systems caused by critical illness . This may be supported by the findings of Lankisch et al ., who reported that the most common causes of death were cardiovascular and cerebrovascular diseases .…”

Are Aggressive Treatment Strategies Less Cost‐Effective for Older Patients? The Case of Ventilator Support and Aggressive Care for Patients with Acute Respiratory Failure

“…[1][2][3]7,[25][26][27][28] Similar to our findings, prior research has shown good functional outcomes and long-term survival for patients with respiratory failure who survive the index hospitalization. 1,26,27,29 A recent study by Ely et al examined resource use and survival for patients treated with mechanical ventilation and found that patients who were 75 and older had similar survival but lower costs of care than patients younger than 75. 30 Prior studies also have shown that the incremental cost-effectiveness of more aggressive treatment strategies varies widely according to patients' characteristics and severity of illness.…”

“…30 Prior studies also have shown that the incremental cost-effectiveness of more aggressive treatment strategies varies widely according to patients' characteristics and severity of illness. 3,26,29,[31][32][33] Severity of illness has been shown to be a much more important determinant of outcomes from serious illness than patient age. 34 Selected invasive treatments can be cost-effective, even for very old patients.…”

The nursing care recording system. A preliminary study of a system for assessment of nursing care demands in the ICU

“…An increase in the amount of nursing care is more often caused by changes in thc severity of patients' illness than by the introduction of new activities in the intensive care unit (ICU). The demand for documentation of the level and quality of nursing care has resulted in the development of different systems for the evaluation of nursing care in ordinary wards (1)(2)(3). These methods are based on either a factor evaluation, by which simple physical observations ("indicators") are used to describe the different patient categories, or a prototype evaluation, by which a circumstantial description of the patients' need for physical and psychological care is used to categorize the paticnts.…”