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Management of Patients Requiring Prolonged Mechanical Ventilation^*

Report of a NAMDRC Consensus Conference

Neil R. MacIntyre, MD, FCCP, Chair; Scott K. Epstein, MD, FCCP; Shannon Carson, MD; David Scheinhorn, MD, FCCP; Kent Christopher, MD, FCCP and Sean Muldoon, MD, FCCP

^* From Duke University Medical Center (Dr. MacIntyre), Durham, NC; Tufts New England Medical Center (Dr. Epstein), Boston, MA; University of North Carolina (Dr. Carson), Chapel Hill, NC; Barlow Respiratory Hospital (Dr. Scheinhorn), Los Angeles, CA; University of Colorado (Dr. Christopher), Denver CO; and Kindred Healthcare (Dr. Muldoon), Louisville, KY. A complete list of the participants is given in the ^Appendix.

Correspondence to: Neil R. MacIntyre, MD, FCCP, Box 3911, Duke University Medical Center, Durham, NC 27710; e-mail: neil.macintyre{at}duke.edu

Patients requiring prolonged mechanical ventilation (PMV) are rapidly increasing in number, as improved ICU care has resulted in many patients surviving acute respiratory failure only to then require prolonged mechanical ventilatory assistance during convalescence. This patient population has clearly different needs and resource consumption patterns than patients in acute ICUs, and specialized venues, management strategies, and reimbursement schemes for them are rapidly emerging. To address these issues in a comprehensive way, a conference on the epidemiology, care, and overall management of patients requiring PMV was held. The goal was to not only review existing practices but to also develop recommendations on a variety of assessment, management, and reimbursement issues associated with patients requiring PMV. Formal presentations were made on a variety of topics, and writing groups were formed to address three specific areas: epidemiology and outcomes, management and care settings, and reimbursement. Each group was charged with summarizing current data and practice along with formulation of recommendations. A working draft of the products of these three groups was then created and circulated among all participants. The document was reworked with input from all concerned until a final product with consensus recommendations on 12 specific issues was achieved.

Key Words: assessment • Diagnosis Related Group • epidemiology • long-term acute care • patient management • prolonged mechanical ventilation • reimbursement • short-term acute care

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