NON-ICU CARE OF HEMODYNAMICALLY STABLE MECHANICALLY VENTILATED PATIENTS

Objective: To analyze a 4 1/2-year experience caring for hemodynamical ly stable mechanically ventilated patients on a nonmonitored respirato ry care floor (RCF) for therapeutic outcome, utilization, and costs. D esign: A retrospective medical records review. Setting: ICUs and an RC F of a university-affiliated tertiary care center. Participants: Two h undred twenty-four patients requiring more than 24 h of mechanical ven tilation cared for on the RCF. Results: The mean age of patients was 6 7+/-17 years. Of the admissions, 58% were from the medical ICU, 28% we re from surgical ICUs, and 9.4% were from general medical floors. Pati ents spent 50+/-66 days mechanically ventilated on the RCF. Overall su rvival was 50.4% with 93.8% of surviving patients successfully weaned from mechanical ventilation. Survival by diagnostic group demonstrated highest probability of survival in patients with trauma and lowest in patients with multisystem failure. Of the survivors, 39% were dischar ged home, 34% to a rehabilitation unit, and 24% to a skilled nursing f acility. Savings based on differential of costs between the ICU and RC F, primarily from reduced staffing requirements, were estimated at $4. 1 million. Conclusion: Use of a nonmonitored RCF for the care of hemod ynamically stable mechanically ventilated patients yields acceptable t herapeutic outcomes while providing the institution with increased fle xibility in critical care bed management and significant financial sav ings.