Mechanical ventilation of patients hospitalized on general medical ward: Outcomes and prognostic factors

Background: In some hospitals, patients hospitalized on the medical ward are mechanically ventilated due to a shortage of intensive care unit (ICU) beds. Objective: To determine outcomes and prognostic factors of medical patients mechanically ventilated on general medical wards. Material and Method: A prospective observational study was performed in general medical wards of a 2,000-bed tertiary care university hospital. Results: Ninety-three consecutive medical patients who were mechanically ventilated on a general medical ward were included in the study. Overall mortality rate of patients mechanically ventilated on the general medical ward was 68.8%. Average length of stay was 22.9±28.5 days. Average cost per patient was 61,076.64±87,569.10 Thai baht. In univariate analysis, the APACHE II score of the patients who did not survive was significantly higher than the score of the patients who survived (mean APACHE II score 23.3±7.3 vs. 19.8±5.5 respectively, p = 0.02). Multivariate analysis revealed APACHE II score >22 to be the only independent predictor of death (OR 4.3, 95% CI 1.2-15.2, p = 0.02). Conclusion: Medical patients who are mechanically ventilated on general medical wards have high mortality rate. APACHE II score is a good prognostic factor for predicting risk of death in these patients.