Shoo Kim Lee
Honorary Staff Physician, Mount Sinai Hospital
Dissertation Title: "The Infant Mechanical Ventilator: Time to Kill The Technology Overkill?"
Background. As a result of advances in medical treatment, fewer infants with respiratory distress syndrome (RDS) now require positive pressure mechanical ventilation (PPV), while an increasing number require continuous positive airway pressure (CPAP) support. Objectives. To determine (1) the feasibility of substituting inexpensive CPAP devices for mechanical ventilators in the NICU without reduction in care, (2) whether SNAP (illness severity score) is predictive of ventilator use, (3) whether non-physician health providers affect practice variations and resource consumption in the NICU. Methods. We prospectively studied the CPAP and PPV needs of infants admitted to the 16 bed level II/III NICU at Boston's Beth Israel Hospital and to 45 bed level II/III NICU at the Brigham and Women's Hospital during the ten month period form March to January 1995, and surveyed the infant mechanical ventilator needs of the greater Hartford region in Connecticut. Results. Assuming the pattern of CPAP utilization at the Beth Israel NICU is generally applicable, CPAP devices could be substituted for 46% of all infant mechanical ventilators in the Northern Connecticut region without reduction of care. A strategy of substituting CPAP devices for infant mechanical ventilators where suitable will result in approximate cost savings of $13.5 million annually (sensitivity analysis range $8.5 million to $14.1 million) in the U.S. alone. SNAP is predictive of mechanical ventilator use in the NICU. There exists variation in ventilator use between the Beth Israel, and Brigham and Women's NICUs which cannot be accounted for by differences in patient characteristics, illness severity or physician differences.