Continuous ventilatory support or invasive ventilation refers to the application of ventilation via an invasive artificial airway. For the purposes of this data element, invasive artificial airway is that provided via an endotracheal tube or a tracheostomy tube.

An endotracheal tube can be placed orally or nasally. It is usually employed prior to a surgically placed tracheostomy tube.

With prolonged ventilation, or when prolonged ventilation is expected, a tracheostomy tube is placed surgically.

For the purposes of calculating the duration of continuous ventilatory support, begin calculation with one of the following:

• Initiation of continuous ventilatory support. For example, for patients with endotracheal intubation and subsequent initiation of continuous ventilatory support, begin counting at the time of intubation. Patients with a tracheostomy, begin counting at the point when continuous ventilatory support is begun; or
• Admission of a ventilated patient. For those patients admitted with continuous ventilatory support, begin counting the duration at the time of the admission.

End the calculation with one of the following:

• Extubation (e.g. removal of endotracheal tube);
• Cessation of continuous ventilatory support after any period of weaning. For tracheostomy patients, the tracheal tube may not be withdrawn for days after discontinuation of continuous ventilatory support. Therefore, the duration would end with the cessation of continuous ventilatory support. For weaning, using methods such as positive pressure ventilation or oxygen delivery via a tracheostomy collar, include the weaning in the duration of continuous ventilatory support up to a maximum of 24 hours following cessation, or the removal of the tracheostomy. Where continuous ventilatory support via the tracheostomy recommences > 24 hours following cessation a new period of ventilation commences;
• Discharge, death or transfer of a patient on continuous ventilatory support; or
• Change of episode type.

Subsequent periods of continuous ventilatory support should be added together. For example, if a patient is on continuous ventilatory support on the first day of their admission, then again on the fourth day of their admission, the hours should be added together.

If there is a period of less than 1 hour between cessation and then restarting of ventilatory support, continue counting the duration. If there is removal and immediate replacement of airway devices, continue counting the duration.

Ventilatory support which is provided to a patient during surgery is associated with anaesthesia and is considered an integral part of the surgical procedure. Duration of continuous ventilatory support should not be counted if it is part of a surgical procedure, except in the following circumstances:

• Ventilatory support was performed for respiratory support prior to surgery and then continued during surgery and post surgery; or
• Ventilatory support was initiated during surgery, continues after surgery and for more than 24 hours post surgery. Where a patient has multiple visits to theatre requiring ventilation, each period of ventilation should be considered individually. If the period of ventilation post surgery is ≤ 24 hours it is not considered or used cumulatively with other periods of ventilation in the episode of care.

Hours of ventilatory support should be reported as completed cumulative hours. For example, if the total duration of ventilatory support was 98 hours 45 minutes, report 98 hours. If a patient is intubated and ventilated for < 1 hour the intubation and ventilation are not reported. This includes patients who die or are discharged or transferred.

Australian Consortium for Classification Development 2018. Australian Coding Standards for ICD-10-AM (The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification) and ACHI (The Australian Classification of Health Interventions) (11th edition). Sydney: Independent Hospital Pricing Authority.