Impact of intensive care unit versus general ward monitoring on length of stay in chronic obstructive pulmonary disease patients after bronchoscopic lung volume reduction

Vollständiger Abstract

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BACKGROUND: Bronchoscopic lung volume reduction (BLVR) offers several advantages over lung volume reduction surgery, such as faster recovery, fewer complications, and reduced infection risk; however, it also carries a risk of pneumothorax (PTX). This risk has led to the routine practice of admitting patients for observation to the intensive care unit (ICU) across various hospitals. However, the impact of care level, whether in the ICU or general ward, on length of stay (LOS) and postprocedural complications in BLVR patients remains unknown. This study aims to determine whether acuity of care affects LOS and postprocedural complication rates in patients who underwent BLVR. METHODS: We retrospectively reviewed 240 patients’ electronic medical records, calculated median LOS, and compared factors that influence LOS in patients admitted to the pulmonary ward (PW) and the ICU. RESULTS: Our data revealed no statistically significant difference between the median LOS between patients who were admitted to the PW (median 3 days, 95% confidence interval [CI]: 3–5) versus the ICU (median 3 days, 95% CI: 3–5). Postprocedural complications, including PTX, respiratory failure, arrhythmias requiring intervention, rates of valve removal during admission, and time from identification of PTX to chest tube placement, were similar between PW and ICU. CONCLUSIONS: With structured nursing education, monitoring post-BLVR patients in a nonhigh-acuity setting appears to be a safe alternative to ICU admission in facilities that perform BLVR.