The LTAC Solution for
Respiratory Failure Patients
Two recent articles highlight the important role Long Term Acute Care Hospitals [LTACHs] play in the continuum of care and confirm what Acuity Specialty Hospitals have believed all along: In appropriate patients, the early placement of tracheostomies, along with early transfer from intensive care to the LTACH increases the likelihood that patients will successfully wean from the ventilator.
A meta-analysis published March 11, 2021 in JAMA Otolaryngology-Head & Neck Surgery concluded that performing a tracheostomy within the first seven days of the start of mechanical ventilation decreases the time patients spend on ventilators, shortens their ICU stay and lowers their risk of ventilator associated pneumonia.1
A study published March 24, 2021 in BMC Pulmonary Medicine demonstrated that earlier access to LTACH care is associated with higher weaning probability for LTACH patients, suggesting patients may benefit from earlier discharge to LTACH. The study’s authors concluded that LTACHs benefit patients by providing care specifically dedicated to ventilator weaning in an interdisciplinary team, rehabilitation-focused care model.2
Having a tracheostomy in place is not necessary for a patient to be transferred to the LTACH setting; LTACHs can and do convert endotracheal tubes to tracheostomies. Tracheostomies are beneficial when the focus turns from initial stabilization and treatment to liberating patients from mechanical ventilation, as tracheostomies are more comfortable for patients and allow more effective weaning from sedation.
In addition to benefitting patients, LTACHs offer benefits to the healthcare system as a whole by relieving pressure on hospital intensive care units, reducing over-crowding which may improve outcomes.2
Collaboration between LTCHs and STACs is essential for the care of patients who are difficult to liberate from mechanical ventilation. These patients need specialty care, and Acuity Specialty Hospitals are designed to meet that need.
Chorath, K., et al. (2021) Association of Early vs Late Tracheostomy Placement With Pneumonia and Ventilator Days in Critically Ill Patients. A Metaanalysis. JAMA Otolaryngology Head & Neck Surgery. org/10.1001/jamaoto.2021.0025
Demiralp, B., Koenig, L., Xu, J. et al. (2021) Time Spent in Prior Hospital Stay and Outcomes for Ventilator Patients in Long-Term Acute Care Hospitals. BMC Pulm Med 21, 104. https://doi.org/10.1186/s12890-021-01454-1
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