HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hassenpflug, M. Articles by Palma, C. Search for Related Content PubMed Articles by Hassenpflug, M. Articles by Palma, C.

Post-ICU Mechanical Ventilation: Treatment of 2,369 Patients Over 16 Years at a Regional Weaning Center

Barlow Respiratory Hospital and Research Center, Los Angeles, CA

PURPOSE: To report outcomes of weaning attempts from prolonged mechanical ventilation (PMV), and post-discharge survival, in consecutive patients transferred to Barlow Respiratory Hospital (BRH), a long term acute care hospital (LTAC), over a period of 16 years.

METHODS: Data were collected by trained research personnel from transfer records and throughout the BRH course; telephone survey and Social Security Death Index (SSDI) were used to determine post-discharge survival.

RESULTS: 2,369 patients’ data from June 1988 –December 2003 were entered into the Ventilation Outcomes Database (VOD). Median patient age was 73; 53% were female; 99% with tracheostomy. Smokers: 70% of patients, averaging 54 pack-years. Mean time ventilated prior to BRH transfer was 32 days. On admission: median APACHE III® Acute Physiology Score (APS) was 37; stage II or greater pressure ulceration was present in 42%. Weaning outcome (weaned, ventilator-dependent, or died) was scored at discharge. Patients discharged on part-time mechanical ventilation were scored as ventilator-dependent. Overall: 51.5% weaned, 17.5% remained ventilator-dependent, and 31% died. Median time to wean fell from 29 days to 17 days (p<0.05) in 1998, with protocol use. One-year post-discharge survival is 40% for the entire VOD. For the cohort admitted March 2002-February 2003 (n=186): Weaned: 49%, with 38% alive at 1 year; ventilator-dependent: 22%, with 10% alive at one year.

CONCLUSION: More than half of BRH patients were liberated from PMV. One-year post-discharge survival has been consistent throughout at approximately 40%, the large majority of those survivors patients discharged weaned from the ventilator. Time to wean was halved with the use of a therapist-implemented weaning protocol. There are trends toward: admitting older and sicker patients, stabilization of time to wean with the use of the protocol, a decrease in the percent of patients weaned, and the number of patients discharged directly home.

CLINICAL IMPLICATIONS: Transfer of tracheotomized ventilator-dependent patients from the ICU to an LTAC, specializing in weaning, can result in a significant percentage of those patients being weaned from mechanical ventilation.

DISCLOSURE: D.J. Scheinhorn, None.