Noninvasive respiratory care unit

Elpem EH, Silver MR, Rosen RL, et al. The noninvasive respiratory care unit. Patterns of use and financial implications. Chest 1991 99(l) 205-208. 

Patients requiring PMV account for a disproportionate amount of health care costs and resources, with those who are ventilator dependent in the ICU for >21 days accounting for 37% of all ICU costs (29). Therefore, there has been a significant drive to improve outcomes and to increase non-ICU facilities, where such patients can receive appropriate care. The decision to transfer a patient who requires PMV may be difficult. Clinical stability and a determination that the patient s staffing needs will be met are necessary before transfer to a step-down unit. A noninvasive respiratory care unit is less expensive than an ICU, allows for more effective transition home or to a nonacute care location, fosters patient independence, and improves quality of life (Fig. 1). 

Figure 1 The management of respiratory failure in the United States. Many patients are admitted initially to an acute care hospital. If they wean ptomptiy, they may spend time in an LTAC hospital for rehabilitation, and eventually return home. If they fail to wean, they undergo tracheostomy and are transferred to an LTAC when stable. Weaning attempts continue, and a mincnity of patients return home the rest remain at the LTAC or are transferred to a SNF. Patients who deteriorate while at LTACs or at home return to the acute care hospital fOT stabilization. Some patients with chronic respiratory failure do not require acute care but are ventilated noninvasively and remain home. Abbreviations COPD, chronic obstructive pulmonary disease NIV, noninvasive ventilation LTAC, long-term acute care SNF, skilled nursing facility.

In May 2002, Vianna et al. (9) evaluated LTV in patients with a stay >30 days, in 77 ICUs in Rio de Janeiro, noting by telephone interview that 26 were publicly funded and 51 were in the private system. There were 645 patients of whom 62 (9.6%) met the criteria for prolonged stay. The main causes were pulmonary and neurological illness. Invasive ventilation was used in 93% of public and 79% of private units. Noninvasive ventilation was not registered in public units, but used in 12% of private patients. The authors noted that noninvasive positive pressure ventilation (NIPPV) in specialized respiratory units would reduce costs as well as length of stay in the ICU. A study conducted by nurses (10) in the ventilator-dependent pediatric population improved the process of family care during their ICU stay and when at home. 

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