Terminal Withdrawal of Mechanical Ventilation at a Long-term Acute Care Hospital

Trend Analysis of Hospital Resource Utilization for Prolonged Mechanical Ventilation Patients in Taiwan: A Population-Based Study

“…7 Although many studies have evaluated PMV outcomes, few longitudinal studies have exceeded 2 years, [1][2][3][4][5] and most published data are limited to United States or European populations. [1][2][3][4][5][6] Therefore, the findings of previous studies of PMV outcomes may not be generalizable to patient populations in Asian countries. Further, no studies have longitudinally evaluated temporal trends in hospital resource utilization by PMV patients, and none have systematically evaluated associations with hospital resource utilization in this patient group.…”

“…However in the 1990s, changes in the medical care reimbursement regulations of the Taiwan healthcare system created incentives to transfer patients requiring PMV from ICUs of acute care hospitals to long-term assisted care facilities. [2][3][4][5][6] The policy for PMV patients implemented by the Taiwan Bureau of National Health Insurance (BNHI) in 2000 required the transfer of such patients to a respiratory care center after an ICU stay of 21 days, and to a respiratory care ward after a respiratory care center stay of 42 days. 7 Although many studies have evaluated PMV outcomes, few longitudinal studies have exceeded 2 years, [1][2][3][4][5] and most published data are limited to United States or European populations.…”

A Two-Group Trial of a Terminal Ventilator Withdrawal Algorithm: Pilot Testing

“…Some patients choose ventilator withdrawal while conscious and able to report dyspnea. 2 A majority undergoing withdrawal, however, are critically ill, cognitively impaired, or unconscious and unable to self-report dyspnea; these patients may or may not be able to experience respiratory distress depending on the severity of unconsciousness. 3 If the patient has been intubated for only a short time, subsequent extubation of the endotracheal tube is not expected to produce airway complications.…”

Long-Term Mechanical Ventilation: Management Strategies

“…Compassionate weaning from PMV (removing the patient from the mechanical ventilator and treating for comfort) can be performed successfully in the LTAC setting, and differs from that performed in the ICU in a number of ways. 51 Outcome data show substantial mortality over time for subsets of patients who require long-term MV. The 3 year survival rate is Ͻ 50% for patients with COPD, and about 70% for patients with either neuromuscular disease or who are post surgery.…”