Additionally, there is growing recognition that a different approach to weaning is required in instances of prolonged ventilator dependency. The NRCU staff had expertise in developing and implementing long-term weaning strategies.
This study documents the high overall costs of care for patients on mechanical ventilators, the magnitude of the financial loss to hospitals providing such care, and the reduction in costs of hospitalization associated with NRCU placement. We were unable to detect whether placement in the NRCU affected overall length of hospitalization for mechanically ventilated patients. We can speculate that reduced hospital stays might have occurred as a result of fewer complications from invasive monitoring or to reduction in the total number of ventilator days. Fewer ventilator days could have resulted from more aggressive monitoring and therapy to prevent respiratory failure and intubation, expedited weaning, expedited discharge of unwean-able patients, or earlier consideration to withdrawal of support from patients with hopeless prognoses. Ideally, a prospective, randomized study comparing care settings (MICU vs NRCU vs general unit) could provide data to definitively compare costs and outcomes of care provided in various settings. Realistically, it is unlikely that this type of study could pass review by a human investigations committee.