Outcomes of Prolonged Mechanical Ventilation Before and After Implementation of a Respiratory ICU

Abstract

Background: Respiratory ICUs (RICUs) have recently been implemented in France to fill the gap between ICUs and respiratory wards for patients who will require prolonged mechanical ventilation (PMV). The aim of this study was to describe the outcomes of subjects with tracheostomy who were undergoing PMV before and after implementing a RICU in our hospital.

Methods: Two cohorts were studied and followed up for 1 year. Cohort 1 included 66 subjects from December 2010 to December 2012, before implementing the RICU. Cohort 2 included 103 consecutive subjects included in the RICU from January 2016 to June 2017.

Results: In cohort 2, lung and airway diseases were the main causes of chronic respiratory failure in 91.3% of the subjects versus 47.0% of the subjects in cohort 1 (P < .001). During the follow-up, 34.8% and 24.3% of the subjects in cohorts 1 and 2, respectively, were readmitted at least once (P = .14), which corresponded to 109 and 137 stays for cohorts 1 and 2. The median (95% CI) length of stay was 42 (37-50) d in the pre-RICU period versus 29 (26-33) d in the RICU period (P < .001). A complete or partial weaning was achieved in 30.3% of stays in the pre-RICU period versus 69.3% of stays in the RICU period (P < .001). The in-hospital mortality rate was 14.7% and 7.3% in the pre-RICU and RICU periods, respectively (P = .10). The 1-year survival did not differ between cohorts: 60.6% versus 53.9% in cohorts 1 versus 2; P = .42).

Conclusions: Implementing a RICU improved the outcomes of the subjects with tracheostomy who were undergoing PMV by reducing the length of stay and increasing complete or partial weaning. However, the 1-year survival remained unchanged.

Keywords: chronic respiratory failure; health outcomes; intermediate care facility; prolonged mechanical ventilation; respiratory intensive care units; tracheostomy.