Abstract
BackgroundTo evaluate the economic implications of the pre-emptive use of extracorporeal carbon dioxide removal (ECCO2R) to avoid invasive mechanical ventilation (IMV) in patients with hypercapnic ventilatory insufficiency failing non-invasive ventilation (NIV).MethodsRetrospective ancillary cost analysis of data extracted from a recently published multicentre case–control-study (n = 42) on the use of arterio-venous ECCO2R to avoid IMV in patients with acute on chronic ventilatory failure. Cost calculations were based on average daily treatment costs for intensive care unit (ICU) and normal medical wards as well as on the specific costs of the ECCO2R system.ResultsIn the group treated with ECCO2R IMV was avoided in 90 % of cases and mean hospital length of stay (LOS) was shorter than in the matched control group treated with IMV (23.0 vs. 42.0 days). The overall average hospital treatment costs did not differ between the two groups (41.134 vs. 39.366 €, p = 0.8). A subgroup analysis of patients with chronic obstructive pulmonary disease (COPD) revealed significantly lower median ICU length of stay (11.0 vs. 35.0 days), hospital length of stay (17.5 vs. 51.5 days) and treatment costs for the ECCO2R group (19.610 vs. 46.552 €, p = 0.01).ConclusionsAdditional costs for the use of arterio-venous ECCO2R to avoid IMV in patients with acute-on-chronic ventilatory insufficiency failing NIV may be offset by a cost reducing effect of a shorter length of ICU and hospital stay.
Highlights
To evaluate the economic implications of the pre-emptive use of extracorporeal carbon dioxide removal (ECCO2R) to avoid invasive mechanical ventilation (IMV) in patients with hypercapnic ventilatory insufficiency failing non-invasive ventilation (NIV)
A new strategy of applying Extracorporeal carbon dioxide removal (ECCO2R) to avoid IMV and its side-effects in patients with hypercapnic acute-on-chronic ventilatory failure not responding to non-invasive ventilation (NIV) has been described [6,7,8,9,10]
The most common condition of acute-on-chronic ventilatory failure frequently leading to intensive care unit (ICU) admissions is an acute exacerbation of a chronic obstructive pulmonary disease (COPD) [11]
Summary
To evaluate the economic implications of the pre-emptive use of extracorporeal carbon dioxide removal (ECCO2R) to avoid invasive mechanical ventilation (IMV) in patients with hypercapnic ventilatory insufficiency failing non-invasive ventilation (NIV). Over the last decades invasive mechanical ventilation (IMV) is increasingly applied to critically ill patients of a more and more ageing and comorbid population [1]. A new strategy of applying ECCO2R to avoid IMV and its side-effects in patients with hypercapnic acute-on-chronic ventilatory failure not responding to non-invasive ventilation (NIV) has been described [6,7,8,9,10]. Once IMV is commenced after failure of NIV, especially patients with chronic pulmonary disease carry an increased risk of prolonged weaning and length of ICU stay and their overall prognosis deteriorates [12,13,14,15,16,17,18]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
