Mechanical ventilation in rural ICUs

Background: In recent years, rural hospitals have expanded their scope of s pecialized services, which has led to the development and staffing of rural intensive care units (ICUs). There is little information about the breadth , quality or outcomes of these services. This is particularly true for spec ialized ICU services such as mechanical ventilation, where little, if any, information exists specifically for rural hospitals. The long-term objectiv es of this project were to evaluate the quality of medical care provided to mechanically ventilated patients in rural ICUs and to improve patient care through an educational intervention. This paper reports baseline data on p atient and hospital characteristics for both rural and rural referral hospi tals. Results: Twenty Iowa hospitals were evaluated. Data collected on 224 patien ts demonstrated a mean age of 70 years and a mean ICU admission Acute Physi ology and Chronic Health Evaluation (APACHE) II score of 22, with an associ ated 36% mortality. Mean length of ICU stay was 10 days, with 7.7 ventilate d days. Significant differences were found in both institutional and patien t variables between rural referral hospitals and rural hospitals with more limited resources. A subgroup of patients with diagnoses associated with co mplex ventilation had higher mortality rates than patients without these co nditions. Patients who developed nosocomial events had longer mean ventilat or and ICU days than patients without nosocomial events. This study also fo und ICU practices that frequently fell outside the guidelines recommended b y a task force describing minimum standards of care for critically ill pati ents with acute respiratory failure on mechanical ventilation. Conclusions: Despite distinct differences in the available resources betwee n rural referral and rural hospitals, overall mortality rates of ventilated patients are similar. Considering the higher mortality rates observed in p atients with complicated medical conditions requiring complex ventilation m anagement, the data may suggest that this subgroup could benefit from treat ment at a tertiary center with greater resources and technology.