Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Association between Medical Costs and the ProVent Model in Patients Requiring Prolonged Mechanical Ventilation

  • Roh, Jiyeon (Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Shin, Myung-Jun (Department of Rehabilitation Medicine, Pusan National University School of Medicine) ;
  • Jeong, Eun Suk (Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Kwangha (Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine)
  • Received : 2018.08.07
  • Accepted : 2018.10.29
  • Published : 2019.04.30
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Abstract

Background: The purpose of this study was to determine whether components of the ProVent model can predict the high medical costs in Korean patients requiring at least 21 days of mechanical ventilation (prolonged mechanical ventilation [PMV]). Methods: Retrospective data from 302 patients (61.6% male; median age, 63.0 years) who had received PMV in the past 5 years were analyzed. To determine the relationship between medical cost per patient and components of the ProVent model, we collected the following data on day 21 of mechanical ventilation (MV): age, blood platelet count, requirement for hemodialysis, and requirement for vasopressors. Results: The mortality rate in the intensive care unit (ICU) was 31.5%. The average medical costs per patient during ICU and total hospital (ICU and general ward) stay were 35,105 and 41,110 US dollars (USD), respectively. The following components of the ProVent model were associated with higher medical costs during ICU stay: age <50 years (average 42,731 USD vs. 33,710 USD, p=0.001), thrombocytopenia on day 21 of MV (36,237 USD vs. 34,783 USD, p=0.009), and requirement for hemodialysis on day 21 of MV (57,864 USD vs. 33,509 USD, p<0.001). As the number of these three components increased, a positive correlation was found betweeen medical costs and ICU stay based on the Pearson's correlation coefficient (${\gamma}$) (${\gamma}=0.367$, p<0.001). Conclusion: The ProVent model can be used to predict high medical costs in PMV patients during ICU stay. The highest medical costs were for patients who required hemodialysis on day 21 of MV.

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References

  1. Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness. Am J Respir Crit Care Med 2010;182:446-54. https://doi.org/10.1164/rccm.201002-0210CI
  2. MacIntyre NR, Epstein SK, Carson S, Scheinhorn D, Christopher K, Muldoon S, et al. Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference. Chest 2005;128:3937-54. https://doi.org/10.1378/chest.128.6.3937
  3. Carson SS. Outcomes of prolonged mechanical ventilation. Curr Opin Crit Care 2006;12:405-11. https://doi.org/10.1097/01.ccx.0000244118.08753.dc
  4. Donahoe MP. Current venues of care and related costs for the chronically critically ill. Respir Care 2012;57:867-86. https://doi.org/10.4187/respcare.01656
  5. Cox CE, Carson SS, Govert JA, Chelluri L, Sanders GD. An economic evaluation of prolonged mechanical ventilation. Crit Care Med 2007;35:1918-27. https://doi.org/10.1097/01.CCM.0000275391.35834.10
  6. Carson SS, Garrett J, Hanson LC, Lanier J, Govert J, Brake MC, et al. A prognostic model for one-year mortality in patients requiring prolonged mechanical ventilation. Crit Care Med 2008;36:2061-9. https://doi.org/10.1097/CCM.0b013e31817b8925
  7. Carson SS, Kahn JM, Hough CL, Seeley EJ, White DB, Douglas IS, et al. A multicenter mortality prediction model for patients receiving prolonged mechanical ventilation. Crit Care Med 2012;40:1171-6. https://doi.org/10.1097/CCM.0b013e3182387d43
  8. Leroy G, Devos P, Lambiotte F, Thevenin D, Leroy O. Oneyear mortality in patients requiring prolonged mechanical ventilation: multicenter evaluation of the ProVent score. Crit Care 2014;18:R155. https://doi.org/10.1186/cc13994
  9. Mok JH, Kim YH, Jeong ES, Eom JS, Kim MH, Kim KU, et al. Clinical application of the ProVent score in Korean patients requiring prolonged mechanical ventilation: a 10-year experience in a university-affiliated tertiary hospital. J Crit Care 2016;33:158-62. https://doi.org/10.1016/j.jcrc.2016.02.017
  10. Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301-8. https://doi.org/10.1056/NEJM200005043421801
  11. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83. https://doi.org/10.1016/0021-9681(87)90171-8
  12. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29. https://doi.org/10.1097/00003246-198510000-00009
  13. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10. https://doi.org/10.1007/BF01709751
  14. Kim WY, Jo EJ, Eom JS, Mok J, Kim MH, Kim KU, et al. Validation of the Prognosis for Prolonged Ventilation (ProVent) score in patients receiving 14days of mechanical ventilation. J Crit Care 2018;44:249-54. https://doi.org/10.1016/j.jcrc.2017.11.029
  15. Kim JH, Hong SK, Kim KC, Lee MG, Lee KM, Jung SS, et al. Influence of full-time intensivist and the nurse-to-patient ratio on the implementation of severe sepsis bundles in Korean intensive care units. J Crit Care 2012;27:414.e11-21. https://doi.org/10.1016/j.jcrc.2012.03.010
  16. Kwak SH, Jeong CW, Lee SH, Lee HJ, Koh Y. Current status of intensive care units registered as critical care subspecialty training hospitals in Korea. J Korean Med Sci 2014;29:431-7. https://doi.org/10.3346/jkms.2014.29.3.431
  17. Lim CM, Kwak SH, Suh GY, Koh Y. Critical care in Korea: present and future. J Korean Med Sci 2015;30:1540-4. https://doi.org/10.3346/jkms.2015.30.11.1540
  18. Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, et al. Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia. JAMA Intern Med 2015;175:363-71. https://doi.org/10.1001/jamainternmed.2014.7386

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