Agitation during prolonged mechanical ventilation at a long-term acute care hospital: risk factors, treatments, and outcomes.

Introduction: The prevalence, risk factors, treatment practices, and outcomes of agitation in patients undergoing prolonged mechanical ventilation (PMV) in the long-term acute care hospital (LTACH) setting are not well understood. We compared agitation risk factors, management strategies, and outcomes between patients who developed agitation and those who did not, in LTACH patients undergoing PMV.

Methods: Patients admitted to an LTACH for PMV over a 1-year period were categorized into agitated and nonagitated groups.

Accidental decannulation following placement of a tracheostomy tube.

Background: Accidental decannulation is a cause of substantial morbidity and mortality in patients in long-term acute care hospitals who require a tracheostomy tube.

Objective: To analyze features of accidental decannulation (AD) following placement of a tracheostomy tube, and to implement strategies to reduce the problem.

Methods: An analysis of data collected prospectively for quality management in a long-term acute care hospital was performed.

Unplanned transfers following admission to a long-term acute care hospital: a quality issue.

The unplanned transfer of patients from long-term acute care hospitals (LTACHs) back to acute facilities disrupts the continuity of care, delays recovery and increases the cost of care. This study was performed to better understand the unplanned transfer of patients with pulmonary disease. A retrospective analysis of data obtained for quality management in a cohort of patients admitted to an LTACH system over a 3-year period.

Tracheostomy decannulation.

Tracheostomy tubes are placed for a variety of reasons, including failure to wean from mechanical ventilation, inability to protect the airway due to impaired mental status, inability to manage excessive secretions, and upper-airway obstruction. A tracheostomy tube is required in approximately 10% of patients receiving mechanical ventilation and allows the patient to move to a step-down unit or long-term care hospital. The presence of a tracheostomy tube in the trachea can cause complications, including tracheal stenosis, bleeding, infection, aspiration pneumonia, and fistula formation from the trachea to either the esophagus or the innominate artery.

When to change a tracheostomy tube.

Knowing when to change a tracheostomy tube is important for optimal management of all patients with tracheostomy tubes. The first tracheostomy tube change, performed 1-2 weeks after placement, carries some risk and should be performed by a skilled operator in a safe environment. The risk associated with changing the tracheostomy tube then usually diminishes over time as the tracheo-cutaneous tract matures.

Terminal withdrawal of mechanical ventilation at a long-term acute care hospital: comparison with a medical ICU.

Background: Failure to wean from prolonged mechanical ventilation (MV) is common in long-term acute care hospitals (LTACHs), but the process of terminal withdrawal of MV in LTACHs is not well described. We compared terminal withdrawal of MV at an LTACH with that in a medical ICU (MICU).

Methods: A retrospective medical chart review was done of all patients undergoing terminal withdrawal of MV in an LTACH (n = 30) and in a MICU (n = 74) over a 2-year period.