National Trends (2009–2013) for Palliative Care Utilization for Patients Receiving Prolonged Mechanical Ventilation*

Chatterjee, Kshitij; Goyal, Abhinav; Kakkera, Krishna; Harrington, Sarah; Corwin, Howard L.

doi:10.1097/ccm.0000000000003182

Cited by 23 publications

(11 citation statements)

References 27 publications

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“…This can also help redirect resources including ventilators which are currently in high demand. 5,9,10 Therefore, this is a clear advantage of fully using palliative care in such circumstances.…”

Section: Discussionmentioning

confidence: 99%

Palliative Care Utilization Among Patients With COVID-19 in an Underserved Population: A Single-Center Retrospective Study

Haydar

Goyal

et al. 2020

Journal of Pain and Symptom Management

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Background. As health-care institutions mobilize resources to address the coronavirus disease 2019 (COVID-19) pandemic, palliative care may potentially be underutilized. It is important to assess the use of palliative care in response to the COVID-19 pandemic.Methods. This is a retrospective single-center study of patients with COVID-19 diagnosed via reverse transcriptase-polymerase chain reaction assay admitted between March 1, 2020, and April 24, 2020. An analysis of the utilization of palliative care in accordance with patient comorbidities and other characteristics was performed while considering clinical outcomes. Chi-square test was used to determine associations between categorical variables while t-tests were used to compare continuous variables.Results. The overall mortality rate was 21.5% (n ¼ 52), and in 48% (n ¼ 25) of these patients, palliative care was not involved. Fifty-nine percent (n ¼ 24) of those who had palliative consults eventually elected for comfort measures and transitioned to hospice care. Among those classified as having severe COVID-19, only 40% (n ¼ 31) had palliative care involvement. Of these patients with severe COVID-19, 68% (n ¼ 52) died. Patients who got palliative care consults were of older age, had higher rates of intubation, a need for vasopressors, and were dead.Conclusion. There was a low utilization rate of palliative care in patients with COVID-19. Conscious utilization of palliative care is needed at the time of COVID-19.

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Section: Discussionmentioning

confidence: 99%

Palliative Care Utilization Among Patients With COVID-19 in an Underserved Population: A Single-Center Retrospective Study

Haydar

Goyal

et al. 2020

Journal of Pain and Symptom Management

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“…Shortening the time to extubation has financial and medical implications. Prolonged mechanical ventilation stresses health care resources and increases financial expenditures related to the development of co-morbid conditions [25][26][27][28]. The hospital costs of subjects receiving prolonged mechanical ventilation (> 96 h) in the United States of America as of 2003 were three times that for subjects being ventilated for less than 36 h. In addition, hospital length of stay was nearly triple for the prolonged mechanical ventilation and these subjects are less likely to be discharged home and more likely to be transferred to a skilled nursing care facility [26].…”

Section: Discussionmentioning

confidence: 99%

The Utility of Diaphragm Ultrasound in Reducing Time to Extubation

McCool

Oyiengo

Koo

2020

Lung

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Purpose Prediction of optimal timing for extubation of mechanically ventilated patients is challenging. Ultrasound measures of diaphragm thickness or diaphragm dome excursion have been used to aid in predicting extubation success or failure. The aim of this study was to determine if incorporating results of diaphragm ultrasound into usual ICU care would shorten the time to extubation. Methods We performed a prospective, randomized, controlled study at three Brown University teaching hospitals. Included subjects underwent block randomization to either usual care (Control) or usual care enhanced with ultrasound measurements of the diaphragm (Intervention). The primary outcome was the time to extubation after ultrasound, and the secondary outcome was the total days on the ventilator. Only intensivists in the Intervention group would have the ultrasound information on the likelihood of successful extubation available to incorporate with traditional clinical and physiologic measures to determine the timing of extubation. Results A total of 32 subjects were studied; 15 were randomized into the Control group and 17 into the Intervention group. The time from ultrasound to extubation was significantly reduced in the Intervention group compared to the Control group in patients with a ∆tdi% ≥ 30% (4.8 ± 8.4 vs 35.0 ± 41.0 h, p = 0.04). The time from ultrasound to extubation was shorter in subjects with a normally functioning diaphragm (∆tdi% ≥ 30%) compared to those with diaphragm dysfunction (∆tdi% < 30%) (23.2 ± 35.2 vs 57.3 ± 52.0 h p = 0.046). When combining the Intervention and Control groups, a value of ∆tdi% ≥ 30% for extubation success at 24 h provided a sensitivity, specificity, PPV and NPV of 90.9%, 86.7%, 90.9%, and 86.7%, respectively. Conclusions Diaphragm ultrasound evaluation of ∆tdi% aids in reducing time to extubation.

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“…In most countries, PC is increasingly being used among patients who are on PMV in ICUs (24). With the increasing demand for PC services, numerous physicians will undoubtedly face a situation wherein they may require the communication skills of the PC team at critical moments.…”

Section: Discussionmentioning

confidence: 99%

Experiences with making difficult decisions of the family caregivers of patients on prolonged mechanical ventilation: a qualitative study

Lee¹,

Hsieh

Chang³

et al. 2020

Ann Palliat Med

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Background: Family caregivers of patients on prolonged mechanical ventilation (PMV) may encounter challenges concerning medical decision-making besides witnessing patient suffering. Palliative care (PC) should be a good support for both patients and caregivers; however, for PMV families, PC is not always a choice through long companion time. This qualitative study clarifies family caregivers' burden of assisting patients on PMV and evaluates the need for PC information and support.Methods: Interviews were caregivers of patients on ventilator support for more than 60 days in five hospitals of the Taipei City Hospital System. Based on phenomenology, this study was conducted by using a semi-structured questionnaire comprising three questions: (I) what was the most crucial moment of deciding to intubate? (II) how would you describe the quality of life of your ventilator-dependent family member? (III) what type of assistance do you expect from the PC team for your ventilator-dependent family member?Results: Twenty-one caregivers of patients on PMV in five hospitals of the Taipei City Hospital System agreed to participate in face-to-face interviews. The identified themes, including stressful decision-making, companion pain/discomfort, and unwillingness to accept PC, elucidated the difficulties experienced by caregivers when providing care.Conclusions: Understanding family caregivers' experiences can enable physicians to improve communication with them, encourage the PC team to support them during surrogate decision-making for patients on PMV during critical moments, and enhance the overall PC service.

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National Trends (2009–2013) for Palliative Care Utilization for Patients Receiving Prolonged Mechanical Ventilation*

Cited by 23 publications

References 27 publications

Palliative Care Utilization Among Patients With COVID-19 in an Underserved Population: A Single-Center Retrospective Study

Palliative Care Utilization Among Patients With COVID-19 in an Underserved Population: A Single-Center Retrospective Study

The Utility of Diaphragm Ultrasound in Reducing Time to Extubation

Experiences with making difficult decisions of the family caregivers of patients on prolonged mechanical ventilation: a qualitative study

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