Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitals

Background Long-term acute care hospitals (LTACHs) treat mechanical ventilator patients who are difficult to wean and expected to be on mechanical ventilator for a prolonged period. However, there are varying views on who should be transferred to LTACHs and when they should be transferred. The purpose of this study is to assess the relationship between length of stay in a short-term acute care hospital (STACH) after endotracheal intubation (time to LTACH) and weaning success and mortality for ventilated patients discharged to an LTACH. Methods Using 2014–2015 Medicare claims and assessment data, we identified patients who had an endotracheal intubation in STACH and transferred to an LTACH with prolonged mechanical ventilation (defined as 96 or more consecutive hours on a ventilator). We controlled for age, gender, STACH stay procedures and diagnoses, Elixhauser comorbid conditions, and LTACH quality characteristics. We used instrumental variable estimation to account for unobserved patient and provider characteristics. Results The study cohort included 13,622 LTACH cases with median time to LTACH of 18 days. The unadjusted ventilator weaning rate at LTACH was 51.7%, and unadjusted 90-day mortality rate was 43.7%. An additional day spent in STACH after intubation is associated with 11.6% reduction in the odds of weaning, representing a 2.5 percentage point reduction in weaning rate at 18 days post endotracheal intubation. We found no statistically significant relationship between time to LTACH and the odds of 90-day mortality. Conclusions Discharging ventilated patients earlier from STACH to LTACH is associated with higher weaning probability for LTACH patients on prolonged mechanical ventilation. Our findings suggest that delaying ventilated patients’ discharge to LTACH may negatively influence the patients’ chances of being weaned from the ventilator.

Perbedaan Ukuran Kanul Suction Terhadap Perubahan Kadar Saturasi Oksigen Di Ruang ICU RSUD Dr. Moewardi Tahun 2015

Background: Patients treated at the ICU room one of them have an exhalation problem. Most of them needed a helping breath like a mechanical ventilator. Patients who needed a mechanical ventilator have a poor cough, so this secret will be a plaque in the lung cavity. A step to reduce plaque, therefore, doing suction care. There are many actions can be noticed to doing suction care is by choosing a cannula measure. This research works through to a distinguishment of cannula measure for change to titrate saturate oxygen on a rigged patient mechanical ventilator at spatial ICU RSUD Dr. Moewardi. Method: The type of this research is quasi-experimental with pre is and post's test control design's group. The Result: This observational result there is a cannula measure difference for change to titrate saturate oxygen on a rigged patient mechanical ventilator at ICU RSUD Dr. Moewardi Surakarta. kanul's measure 12F have greater influence appealed by kanul's measure 10F which is as big as 0.001, meanwhile, cannula measure 10F has to change as big as 0.029. Conclusion: The difference cannula measure suction having for change to titrate saturated oxygen.