The Interhospital Transfer of Mechanically Ventilated Patients: Too Little, Too Late, and Questionably Motivated?

Patient characteristics associated with increased odds of interhospital transfer included younger age, commercial insurance, lower burdens of chronic disease, fewer acute organ failures, and later initiation of mechanical ventilation and placement of tracheostomy at the source hospital. [...]appropriate multilevel statistical models accounted for the correlation of characteristics within hospitals. [...]the important question of whether outcomes of patients with ventilator-dependent respiratory failure could be improved through interhospital transfer to higher case-volume hospitals remains unexplored. [...]current systems of care that result in patient transfer after tracheostomy may miss opportunities to leverage expertise at centers with greater experience managing mechanically ventilated patients. [...]determinants of hospital reimbursement- including patient insurance status and hospital profit structure-were both associated with transfer practice. The results of the study by Nadig and colleagues suggest a need for further research that explores associations between mechanical ventilation case volume and weaning success, as well as studies of the financial ramifications of interhospital transfer of critically ill patients with ventilator-dependent respiratory failure. Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study.