Riley Hospital for Children, Indianapolis, Indiana.
Pediatric Pulmonary Division, Riley Hospital for Children, Indianapolis, Indiana.
Respir Care. 2020 Aug;65(8):1147-1153. doi: 10.4187/respcare.07342. Epub 2020 Feb 4.
More children are discharged from ICUs on prolonged mechanical ventilation (PMV) via tracheostomy than ever before. These patients have long hospitalizations with high resource expenditure. Our objective was to describe the characteristics of these resource-intensive patients and to evaluate their costs of care. We hypothesized that subjects requiring PMV for neurologic diagnoses would have higher costs, longer hospital length of stay (LOS), and worse outcomes than those with primarily respiratory diagnoses.
We identified 50 pediatric subjects between January 2015 and December 2017 at our institution who had a new tracheostomy placement and were enrolled in a home mechanical ventilation program. Collected data included demographics, indication for tracheostomy, LOS, hospital costs, readmissions, and outcomes. We also compared subjects who required PMV for respiratory diagnoses versus neurologic diagnoses.
Of 50 subjects, 41 were < 12 months old at the time of tracheostomy. Thirty-four subjects had a respiratory diagnosis requiring PMV, 14 had a neurologic diagnosis, and 2 had a cardiac diagnosis. The total initial hospitalization cost was $31,133,582, which averages to $622,671 per subject. The average initial hospitalization LOS was 155 d. Respiratory subjects had longer LOS and higher average costs than neurologic subjects. The average readmission rate was 2.16 per subject in the first year after discharge, and the average readmission cost per subject was $73,144. Eight subjects died in the first year after discharge, and 4 suffered a serious morbidity.
This descriptive study evaluated the social and medical characteristics of subjects being discharged from the pediatric ICU with PMV via tracheostomy, as well as quantified the financial impact of their care. Those requiring PMV for neurologic diagnoses had shorter hospital LOS and lower hospital costs than those with respiratory diagnoses. No definitive differences in outcomes were found.
现在有比以往任何时候都多的儿童在 ICU 接受长时间机械通气（PMV）治疗后通过气管切开术出院。这些患者住院时间长，资源消耗高。我们的目的是描述这些资源密集型患者的特征，并评估他们的护理成本。我们假设，因神经诊断而需要 PMV 的患者比因主要呼吸诊断而需要 PMV 的患者的费用更高，住院时间更长，结果更差。
我们在我院确定了 50 名在 2015 年 1 月至 2017 年 12 月期间接受新气管切开术并参加家庭机械通气计划的儿科患者。收集的数据包括人口统计学资料、气管切开术的适应证、住院时间、医院费用、再入院和结局。我们还比较了因呼吸诊断而需要 PMV 的患者与因神经诊断而需要 PMV 的患者。
在 50 名患者中，有 41 名在气管切开时不到 12 个月大。34 名患者因呼吸诊断需要 PMV，14 名患者因神经诊断需要 PMV，2 名患者因心脏诊断需要 PMV。初始总住院费用为 31133582 美元，平均每位患者为 622671 美元。平均初始住院时间为 155 天。呼吸科患者的住院时间和平均费用均长于神经科患者。出院后第一年的平均再入院率为每位患者 2.16 次，每位患者的平均再入院费用为 73144 美元。出院后第一年有 8 名患者死亡，4 名患者发生严重并发症。
本描述性研究评估了通过气管切开术从儿科 ICU 出院的接受 PMV 治疗的患者的社会和医疗特征，并量化了他们的护理费用。因神经诊断而需要 PMV 的患者的住院时间和住院费用均短于因呼吸诊断而需要 PMV 的患者。在结果方面没有发现明显差异。
