The Science Journal of the American Association for Respiratory Care

1999 OPEN FORUM Abstracts

OUTCOMES OF NEW VENTILATOR TECHNOLOGIES ON PATIENTS IN AN ICU

Steven R. Mitchem, RRT and Joe Dwan, MS, RRT, Kaiser Sunnyside Medical Center, Clackamas, OR.

This retrospective study compares ventilator length of stay (VLOS) over a three year period, Jan. 96-Dec 98. New generation technology ventilators, Siemens Servo 300's, with graphics & PetCO2 monitors were purchased Dec. 1995. Did new modes, graphics & PetCO2 monitor change VLOS? VLOS data was obtained by counting ventilator hours by patient & disease documented by therapists on the patient's billing cardex. The data for specific dx were reviewed before and after implementing the new technologies. We believe that technology differences relating to VLOS would be more evident within the more complex disease DRG categories. VLOS per day was calculated by disease category monthly. We showed a reduction in VLOS over 3 years.

VLOS 1996 1997 1998
ARDS 16.96(n=9) 10.88(n=9) 3.86(n=11)
COPD 3.64(n=14) 10.57(n=14) 2.04(n=26)
CHF/CARDIAC 3.29(n=21) 1.65(n=12) 1.65(n=33)
ARF 4.00(n=45) 2.94(n=33) 2.07(n=46)

Did the many ICU variables determine our VLOS outcomes? The RCP & ICU physician staff remained stable throughout the trail, with 1 turnover each. Nursing staff changed, but protocols (including sedation) remained consistent. Low volume, permissive hypercapnia protection strategy was implemented in 1995. The ventilator acquired pneumonia rates were consistently below national average. Patient acuity remained consistent in our 13 bed ICU. Standard modes changed from SIMV, PS, PC & A/C to PRVC, PC, VS, PS. After considering the above variables, we were left with the new technology hypothesis. We felt the new technologies and the comprehensive training programs undertaken, enabling the staff to best utilize them, represent the greatest improvement in our ventilator management. We therefore concluded that the improvement in outcomes must be primarily related to the application of new ventilator technologies. In conclusion, we freely admit the lack of scientific controls over the variables related to our data. However, we feel the validity of the study has merit. Our volume & facility is small and lacks resources for research. We look to the larger facilities to provide the research to answer these questions. In the end, we are encouraged by the fact that for whatever reasons our VLOS has decreased over this time period. We feel this must be the ultimate goal for any Respiratory Care Department.

OF-99-043

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