Prolonged mechanical ventilation: review of care settings and an update on professional reimbursement.

The goal of this article is to provide an update on recent changes to current procedural terminology codes used for billing physician services for mechanical ventilation in chronic care facilities. In addition to billing information, background data relevant to prolonged mechanical ventilation are reviewed. Topics covered include a description of the settings in which patients receive prolonged mechanical ventilation; home mechanical ventilation; the role of physician extenders; documentation of ventilator services; and reporting and coding ventilator management.

Ventricular lead redundancy to prevent cardiovascular events and sudden death from lead fracture in pacemaker-dependent children.

BACKGROUND: Children requiring a permanent epicardial pacemaker (PM) traditionally have a single lead placed on the right ventricle. Lead failure in pacemaker-dependent (PMD) children, however, can result in cardiovascular events (CVEs) and death. OBJECTIVE: The purpose of this study was to determine if redundant ventricular lead systems (RVLS) can safeguard against CVE and death in PMD children. METHODS: This was a single-center study of PMD patients undergoing placement of RVLS from 2002-2013. Patients ≤21 years of age who were PMD were included. Patients with a biventricular (BiV) system placed for standard resynchronization indications were excluded. RVLS patients were compared to PMD patients with only a single pacing lead on the ventricle (SiV). RESULTS: Seven hundred sixty-nine patients underwent PM/implantable cardioverter-defibrillator placement with 76 BiV implants; 49 patients (6%) were PMD. Thirteen patients underwent implantation of an RVLS. There was no difference between the RVLS group (n = 13) and SiV PMD control group (n = 24) with regard to age (RVLS 9.5 ± 5.8 years vs SiV 9.4 ± 6.7 years, P = .52), weight (RVLS 38.2 ± 32.6 kg vs SiV 35.2 ± 29.3 kg, P = .62), indication for pacing, procedural complications, or time to follow-up. There were 2 lead fractures (17%) in the RVLS group (mean follow-up 3.8 ± 2.9 years), with no deaths or presentations with CVE. The SiV control group had 3 lead fractures (13%) (mean follow-up 2.8 ± 2.9 years), with no deaths, but all 3 patients presented with CVE and required emergent PM placement. CONCLUSION: RVLS systems should be considered in children who are PMD and require permanent epicardial pacing. BiV pacing and RVLS may decrease the risk of CVE in the event of lead failure in PMD patients.

Decannulation following tracheostomy for prolonged mechanical ventilation.

BACKGROUND: We examined the process of decannulation following tracheostomy in patients transferred to a long-term acute care (LTAC) hospital for weaning from prolonged mechanical ventilation (PMV). METHODS: A retrospective chart review of 135 patients. RESULTS: Decannulation was successful in 35% of patients a median of 45 days (IQR, 32-76) following tracheostomy. Patients who failed decannulation had a tracheostomy tube placed earlier (14 days; IQR 11-18 vs. 18 days; IQR 14-30, P=.04) and had a shorter length of stay at the acute facility (20 days; IQR, 16-23 vs. 31 days; IQR 24-45, P=.003) compared with patients who were decannulated. Length of stay and cost of care at the LTAC did not differ with decannulation status. At 3.5 years, 35% (47/135) of all patients and 62% (29/47) of decannulated patients were alive. CONCLUSIONS: Decannulation was achieved in 35% of patients transferred to an LTAC for weaning from prolonged mechanical ventilation.