Cohen I L, Booth F V
Division of Surgical Critical Care, State University of New York at Buffalo.
New Horiz. 1994 Aug;2(3):283-90.
In many ICUs, admission and discharge hinge on the need for intubation and ventilatory support. As few as 5% to 10% of ICU patients require prolonged mechanical ventilation, and this patient group consumes > or = 50% of ICU patient days and ICU resources. Prolonged ventilatory support and chronic ventilator dependency, both in the ICU and non-ICU settings, have a significant and growing impact on healthcare economics. In the United States, the need for prolonged mechanical ventilation is increasingly recognized as separate and distinct from the initial diagnosis and/or procedure that leads to hospitalization. This distinction has led to improved reimbursement under the prospective diagnosis-related group (DRG) system, and demands more precise accounting from healthcare providers responsible for these patients. Using both published and theoretical examples, mechanical ventilation in the United States is discussed, with a focus on cost containment. Included in the discussion are ventilator teams, standards of care, management protocols, stepdown units, rehabilitation units, and home care. The expanding role of total quality management (TQM) is also presented.
在许多重症监护病房（ICU），患者的收治与出院取决于是否需要插管和通气支持。在ICU患者中，仅有5%至10%的患者需要长时间机械通气，而这部分患者消耗的ICU住院天数和ICU资源占比≥50%。无论是在ICU还是非ICU环境中，长时间通气支持和慢性呼吸机依赖对医疗经济学都有着重大且日益增加的影响。在美国，长时间机械通气的需求越来越被视为与导致住院的初始诊断和/或手术不同且独立的情况。这种区分使得在前瞻性诊断相关分组（DRG）系统下的报销有所改善，并且要求负责这些患者的医疗服务提供者进行更精确的核算。本文通过已发表的和理论上的实例，对美国的机械通气进行了讨论，重点是成本控制。讨论内容包括呼吸机团队、护理标准、管理方案、降级病房、康复病房和家庭护理。还介绍了全面质量管理（TQM）不断扩大的作用。
