Improved survival for an integrated system of reduced intensive respiratory care for patients requiring prolonged mechanical ventilation

[[abstract]]Background: The introduction of reduced respiratory care may lead to worse long-term outcomes for patients undergoing prolonged mechanical ventilation (PMV) for more than 21 days. The objective of this study is to determine the survival for an integrated system of reduced intensive respiratory care (ISRIRC) by Taiwan National Health Insurance in patients requiring PMV. Methods: A 10-year retrospective study was performed in a 1,000-bed teaching hospital in Taiwan. A total of 633 consecutive PMV patients transferred from the hospital between 1998 and 2007 were enrolled. Medical records were reviewed to collect the clinical data, which were linked to the National Death Certification Database to ascertain patient survival. Kaplan-Meier estimates were performed, and a Cox proportional hazards model was constructed. We further conducted a corroboration study and retrieved a systematically randomized nation-wide sample of PMV patients with combined septicemia and shock and compared the survival functions of those who were treated before and after the integrated system, including 228 and 2,677 patients, respectively. Results: The survival rates at 3 months, 6 months and one year were 60.0%, 44.0% and 30.0%, respectively. The one-year survival rates of the patients before and after ISRIRC were 21.0% and 37.2%, respectively (p