Dr TANG Wai Ming
ABSTRACT
OBJECTIVES. To determine the outcome in adult patients on general medical wards who were mechanically ventilated.
DESIGN. Retrospective observational study.
SETTING. 1100-bed tertiary hospital in Hong Kong.
SUBJECTS AND METHODS. The subjects were adult patients admitted during a 2.5-year period who required mechanical ventilation and were managed on general medical wards without admission to ICU or other special care areas. They were identified through the Clinical Data Analysis Reporting System and the ventilator loan records.
RESULTS. A total of 755 patients were studied. The observed number of deaths was 672 and the mortality rate was 89.0%. The expected number of deaths was 569.5 as derived from the Mortality Probability Model II system admission model. The standardized mortality ratio was 118.0 (95% CI 109.3 to 127.3, p <0.0005). The incidence of ventilator-associated pneumonia was 19.0 events per 1000 ventilator-days. The incidence rates of pressure sores and stress ulcer bleeding were 8.5 and 10.2 per 1000 patient-days respectively. Patients of chronic obstructive pulmonary disease (COPD) had a lower mortality rate of 70.8% (p <0.005) than overall patients or patients of other diagnoses in subgroup analysis. The post cardiac arrest subgroup had the highest mortality 99.0%.
CONCLUSION. There was a worse than predicted survival in the absence of ICU care for the critically ill patients who received mechanical ventilation on general wards. The subgroup of COPD patients warranted more ICU admissions. Early discontinuation of invasive support should be seriously considered in post cardiac arrest patients.