Mechanical Ventilation: Beyond the ICU Quick Reference Guide

Figure 1 graphically lists facilities in ascending and descending order of cost and patient independence.

AVAILABLE MEDICAL RESOURCES (COSTS)		PAITENT INDEPENDENCE (QUALITY OF LIFE)
GREATEST LEAST	ACUTE CARE FACILITY Critical Care Unit Specialized Respiratory Care Unit General Medical Surgical Unit	LEAST GREATEST
	IMMEDIATE CARE FACILITY Subacute Care Long-term Care Hospital Rehabilitation Hospital
	LONG-TERM CARE FACILITY Skilled Nursing Facility Congregate Living Center Home

FIGURE 1. Potential sites for care of VAI. Sites toward the bottom of the figure in general have fewer medical resources and lower costs but allow greater patient independence and a higher quality of life. Modified from Make B. and Gilmartin M. In: Pulmonary rehabilitation: guidelines to success. 2nd ed. Philadelphia: JB Lippincott, 1993; 359-91.

ICU—not appropriate for long-term care of VAIs unless the patient has acute clinical decompensation.

Specialized Respiratory Care Unit—may lower costs but should be viewed as a place to prepare a VAI for discharge to a nonhospital site.

General Medical/Surgical Unit—a long-term VAI may be placed in one of these units as an alternative to special respiratory care, but physiologic monitoring and special training of the unit's caregivers is then needed.

Subacute Care Unit—typically designed to treat patients with complex pathophysiology who require monitoring, IV therapy, or postoperative care not available in a skilled nursing facility.

Long-term Care Hospital—provides care to long-term VAIs, as well as to patients who still need substantial ventilatory support prior to discharge to home or a long-term care facility.

Rehabilitation Hospital—may benefit patients who have specific physical, occupational, speech, developmental, or other rehabilitation goals, and who are motivated to achieve therapy goals and re-enter the community.

Long-term care facilities do not have resources to manage acutely ill patients and are not optimal sites for actively weaning patients from ventilatory assistance.

Skilled Nursing Facility—may be very cost-effective for care of VAIs, especially patients who require extensive nursing care.

Congregate Living Center—preferred by those who aspire to independent living in a group setting.

Home—the preferred site for long-term VAIs in terms of quality of life, given that the patient and patient's family have been fully informed regarding responsibilities and are capable of managing care and care giving.

A long-term VAI should live in a site that maximizes the individual's independence, enhances quality of life, and minimizes cost. The health-care team should be able to help the VAI identify financial resources to reimburse costs of home care.

Consensus Statements

Mechanical Ventilation: Beyond the ICU
Quick Reference Guide

Facilities for Care of a VAI

Acute Care Facilities

Intermediate Care Facilities

Long-term Care Facilities