Long-term ventilator-dependent patients: new facilities and new models of care: the American perspective.

The number of patients who receive mechanical ventilation as life support is rapidly increasing due to improvements in life saving medical therapy in critically ill patients, an aging population and the expanded use of aggressive surgical procedures. The historic annualized increase in prolonged mechanical ventilation use in the U.S. is approximately 5.5% compared with a 1% per annum increase in U.S. hospital admissions. It is estimated that the population of patients who receive prolonged mechanical ventilation in the U.S. will more than double by the year 2020 and reach approximately 605,898 cases. The increased number of patients who require prolonged mechanical ventilation strains the available resources of intensive care units (ICU) by requiring a greater degree of medical care and ICU hospitalization that exceeds the median length of stay. Mechanical ventilation is expensive therapy; patients who receive ventilation in the ICU disproportionately contribute to the high cost of ICU care. Dasta and colleagues reported that ICU patients who require mechanical ventilation compared to ICU patients who do not receive mechanical ventilation have 50% higher costs and treatment with mechanical ventilation accounts for 51% of their total hospital costs. Those who require prolonged ventilation consume an even greater percentage of heath care dollars. In an analysis of over 31 million hospital discharges for adults in 2003, Zilberberg reported a greater median length of stay (17 vs. 6 days) and hospital costs ($40,903 vs. $13,434) for those who received mechanical ventilation ≥96 h compared to those who received mechanical ventilation <96 h. Patients who are ventilated for ≥21 days have even higher costs; the cost per one-year survival is $423,596, $266,105 and $165,075 for patients ventilated ≥21 days, ≥96 h with a tracheostomy and <96 h, respectively. Carson reported on 126 patients ventilated ≥4 days with tracheostomy or ≥21 days without tracheostomy who were treated at one health care system and