Chia-Chen Chu1,2, Chin-Jung Liu1,3,4, Suh-May Yen5, Wen-Yu Chou3, Pei-Tseng Kung6, Yuh-Show Tsai3,4, Wen-Chen Tsai7. 1. Department of Respiratory Therapy. 2. Department of Biomedical Engineering, Chung-Yuan Christian University, Taoyuan City, Taiwan. 3. Department of Health Services Administration. 4. Public Health, China Medical University, Taichung, Taiwan. 5. Department of Chinese Medicine, Nantou Hospital, Nantou, Taiwan. 6. Department of Healthcare Administration, Asia University, Taichung, Taiwan. 7. Department of Biomedical Engineering, Chung-Yuan Christian University, Taoyuan City, Taiwan. wtsai@mail.cmu.edu.tw.
Abstract
BACKGROUND: According to Taiwan's integrated delivery system policy, ventilator-dependent patients are successfully liberated from mechanical ventilation in accordance with step-down care. However, premature discharge affects the 14-d readmission quality index. Therefore, we explored the risk and related factors of subjects liberated from mechanical ventilation who were re-intubated within 14 d. METHODS: This retrospective study analyzed a cohort of ventilator-dependent subjects 17 y of age and older using a population-based database from the Taiwan National Health Research Institutes Database from 2006 to 2010. Chi-square test and logistic regression analyses were used to explore whether subjects liberated from mechanical ventilation were re-intubated within 14 d and to investigate the related factors. RESULTS: A total of 15,840 ventilator-dependent subjects were liberated from mechanical ventilation, and 449 subjects were re-intubated within 14 d; the total re-intubation rate was 2.83%. The factors related to a higher risk of re-intubation were also the reasons for ventilator use, including complications, hospital accreditation level, and the ventilator weaning care stage. A higher risk of re-intubation was identified in subjects with COPD (odds ratio [OR] 1.32, 95% CI 1.02-1.7, P = .035) or pneumonia (OR 1.4, 95% CI 1.07-1.86, P = .02) and in subjects who stayed at a district hospital (OR 3.53, 95% CI 2.48-5.01, P < .001). Liberation from mechanical ventilation in the respiratory care ward and home respiratory care were associated with the highest risk of re-intubation, which was 2.32 times that of ICU subjects (P < .001). CONCLUSIONS: Factors associated with re-intubation within 14 d after ventilator liberation are related to the level and quality of the care setting; thus, to prevent re-intubation, more attention should be paid to higher-risk ventilator-dependent subjects after they are liberated from mechanical ventilation.
BACKGROUND: According to Taiwan's integrated delivery system policy, ventilator-dependent patients are successfully liberated from mechanical ventilation in accordance with step-down care. However, premature discharge affects the 14-d readmission quality index. Therefore, we explored the risk and related factors of subjects liberated from mechanical ventilation who were re-intubated within 14 d. METHODS: This retrospective study analyzed a cohort of ventilator-dependent subjects 17 y of age and older using a population-based database from the Taiwan National Health Research Institutes Database from 2006 to 2010. Chi-square test and logistic regression analyses were used to explore whether subjects liberated from mechanical ventilation were re-intubated within 14 d and to investigate the related factors. RESULTS: A total of 15,840 ventilator-dependent subjects were liberated from mechanical ventilation, and 449 subjects were re-intubated within 14 d; the total re-intubation rate was 2.83%. The factors related to a higher risk of re-intubation were also the reasons for ventilator use, including complications, hospital accreditation level, and the ventilator weaning care stage. A higher risk of re-intubation was identified in subjects with COPD (odds ratio [OR] 1.32, 95% CI 1.02-1.7, P = .035) or pneumonia (OR 1.4, 95% CI 1.07-1.86, P = .02) and in subjects who stayed at a district hospital (OR 3.53, 95% CI 2.48-5.01, P < .001). Liberation from mechanical ventilation in the respiratory care ward and home respiratory care were associated with the highest risk of re-intubation, which was 2.32 times that of ICU subjects (P < .001). CONCLUSIONS: Factors associated with re-intubation within 14 d after ventilator liberation are related to the level and quality of the care setting; thus, to prevent re-intubation, more attention should be paid to higher-risk ventilator-dependent subjects after they are liberated from mechanical ventilation.