Table 1.

Prolonged mechanical ventilation settings for care

Setting	Pros	Cons
ICU	Optimal medical and staffing resources to respond to changes in respiratory status	High costs of care Limited Medicare reimbursement Competing bed space with the acutely ill Limited psychosocial and family support
LTAC	Designed to support acute care patients requiring specialized care and rehabilitation services Lower costs compared with ICUs Higher discharge reimbursements compared with ICUs	Increased patient/staff ratios may jeopardize care compared with ICUs Long-term goals of care are to wean off ventilators or to transition to home, not to support lifetime PMV
Nursing home	Alternative to at-home care when family support and/or resources are inadequate Can support those requiring lifetime PMV, and those who may be weaned in time	Varying accessibility of facilities Must be medically stable Lower discharge reimbursements compared with LTAC facilities
Home	Increased quality of life through family caregiving, psychosocial support, and increased patient autonomy Most cost-effective setting Reduced infection rates	Must be medically stable Requires a stable and safe home environment Requires considerable family and professional caregiver support Continued emergency response education required for all caregivers