Mechanical ventilation of patients hospitalized in medical wards vs the intensive care unit - an observational, comparative study

Background: In some hospitals, patients are mechanically ventilated on the wards in addition to the intensive care unit (ICU) because of the shortage of ICU beds. Objective: The aim of the study was to compare the outcome and ventilatory management of medical patients mechanically ventilated on the medical wards and in the ICU. Design: This was a prospective, observational, noninterventional study over a 6-month period. Setting: The study was conducted in internal medicine wards and the ICU of a 500-bed community university-affiliated hospital. Patients: Ninety-nine mechanically ventilated medical patients in the ICU or on the medical wards because of shortage of ICU beds were included in the study. Results: Baseline characteristics of the patients ventilated in the ICU (group 1) and in the medical wards (group 2) were collected. Thirty-four patients were ventilated in the ICU and 65 in the wards during the study period. In-hospital survival rate in group 1 was 38% vs 20% in group 2 (P <.05). The The Acute Physiologic and Chronic Health Evaluation (APACHE) II score in group 1 was 24 +/- 7 vs 27 +/- 7 in group 2 (P <.05). Other prognostic factors were similar. The age of the survivors in the 2 groups was similar: 57 +/- 25 years in group 1 vs 69 +/- 13 years in group 2 (P = NS). Mean number of ventilatory changes in group 1 was 7.5 +/- 1.4 per day per patient, whereas it was 1.3 +/- 1.0 in group 2 (P <.001). The number of arterial blood gas analyses in group 1 was 7.7 +/- 1.2 per day per patient compared with 2.3 +/- 1.3 in group 2 (P <.001). Twenty percent (20%) of the patients in group I had endotracheal tube-related inadvertent events compared with 62% of the patients in group 2 (P <.05). Conclusions: We conclude that in medical patients requiring mechanical ventilation, there is a higher in-hospital survival rate in ICU-ventilated patients as compared with ventilated patients managed on the medical wards. In addition, ICU provides a better monitoring associated with less endotracheal tube-related complications and more active ventilatory management. (c) 2007 Elsevier Inc. All rights reserved.