Chad Pezzano, RT
Respiratory Therapist
Albany Medical Center, United States
Disclosure information not submitted.
William Yokeley, n/a
Medical Student
Albany Medical College, United States
Disclosure information not submitted.
Shashikanth Reddy Ambati, MD
Assistant Professor
Albany Medical Center
Albany, NY
Disclosure information not submitted.
Javier Sanchez, MD
Clinical Professor
Albany Medical Center, United States
Disclosure information not submitted.
Suzanne Barry, DO
Assistant Professor
Albany Medical Center - The Vascular Group, United States
Disclosure information not submitted.
Adnan Bakar, BA, MD
Associate Professor
Albany Medical Center, United States
Disclosure information not submitted.
Kathleen Ventre, MD
Associate Professor
Albany Medical Center, United States
Disclosure information not submitted.
Nicole Betancourt, MD
Assistant Professor
Albany Medical Center, United States
Disclosure information not submitted.
Title: Resource Utilization of Long-Term Mechanically Ventilated Pediatric Patients on a Regional PICU
Introduction: Children dependent on long-term mechanical ventilation (LTMV) are typically admitted to a pediatric intensive care unit (PICU) from home or long-term acute (LTAC) facilities when hospitalized. Our PICU is a 19-bed mixed medical, surgical and cardiac ICU. There are two LTAC facilities nearby that admit pediatric LTMV patients. The aim of our study was to examine resource utilization of PICU beds by patients requiring mechanical ventilation.
Methods: We completed a retrospective review of all PICU admissions from 2010-2020 that required mechanical ventilation. We analyzed data by admission encounter and by individual patient utilization. Primary analysis examined discharge of patients to home versus LTAC facility. Secondary analysis examined discharge of LTMV patients to home versus LTAC facility. We compared length of stay (LOS), ventilator days and deaths. We reported medians due to skewed distribution.
Results: Analysis of admission encounters revealed a significant difference in ventilator days and deaths between LTAC and non-LTAC groups. LOS was not statistically significant. There were 1474 encounters; 540 were from LTAC facilities. Median number of ventilator days for LTAC and non-LTAC groups were 6 and 4 (p< 0.001), respectively. The non-LTAC group had 112 deaths. The LTAC group had 12 deaths (p< 0.01). Analysis of individual patient utilization revealed significant differences in LOS and ventilator days but not deaths. There were 806 patients; 115 were from LTAC facilities. Median LOS was 23 days for the LTAC group and 8 days for the non-LTAC group (p< 0.01). Median number of ventilator days was 27 for the LTAC group and 5 days for the non-LTAC group (p< 0.01). Secondary analysis revealed insignificant differences between the groups.
Conclusions: Our data shows that the number of ventilator days per admission encounter and per individual patient were significantly different between the two groups irrespective of LTMV status. Children discharged to a LTAC facility had more ventilator days. We surmise that patients discharged to a LTAC facility had longer ventilator days because they are more likely to have multiple comorbidities that impact their need for mechanical ventilation. Examination of severity of illness may allow us to explore the reason for this outcome more objectively.