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 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 1 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.