Mechanical ventilation in rural ICUs

Background:
In recent years, rural hospitals have expanded their scope of
specialized services, which has led to the development and staffing of rural
intensive care units (ICUs). There is little information about the breadth,
quality or outcomes of these services. This is particularly true for
specialized ICU services such as mechanical ventilation, where little, if any,
information exists specifically for rural hospitals. The long-term objectives
of this project were to evaluate the quality of medical care provided to
mechanically ventilated patients in rural ICUs and to improve patient care
through an educational intervention. This paper reports baseline data on
patient and hospital characteristics for both rural and rural referral
hospitals.

      Results:
      Twenty Iowa hospitals were evaluated. Data collected on 224
            patients demonstrated a mean age of 70 years and a mean ICU admission Acute
            Physiology and Chronic Health Evaluation (APACHE) II score of 22, with an
            associated 36% mortality. Mean length of ICU stay was 10 days, with 7.7
            ventilated days. Significant differences were found in both institutional and
            patient variables between rural referral hospitals and rural hospitals with
            more limited resources. A subgroup of patients with diagnoses associated with
            complex ventilation had higher mortality rates than patients without these
            conditions. Patients who developed nosocomial events had longer mean ventilator
            and ICU days than patients without nosocomial events. This study also found ICU
            practices that frequently fell outside the guidelines recommended by a task
            force describing minimum standards of care for critically ill patients with
            acute respiratory failure on mechanical ventilation.


      Conclusions:
      Despite distinct differences in the available resources between
            rural referral and rural hospitals, overall mortality rates of ventilated
            patients are similar. Considering the higher mortality rates observed in
            patients with complicated medical conditions requiring complex ventilation
            management, the data may suggest that this subgroup could benefit from
            treatment at a tertiary center with greater resources and technology.