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A Community-Based Regional Ventilator Weaning Unit : Development and Outcomes

Peter H. Bagley; Elaine Cooney
Author and Funding Information

From the Medical Center of Central Massachusetts, Worcester, Mass, and the Rehabilitation Hospital of Rhode Island, North Smithfield, RI.


1997 by the American College of Chest Physicians


Chest. 1997;111(4):1024-1029. doi:10.1378/chest.111.4.1024
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Published online

Abstract

Study objective: Description of the development of a community-based weaning unit and the outcomes from that unit.

Design: Review of admissions, classified by etiology of ventilator dependence, with attention to disposition, length of stay, and time to wean.

Setting: Long-term acute-care facility in Worcester, Mass.

Patients: Two hundred seventy-eight ventilator-dependent patients admitted to a ventilator unit from 1988 through May 1995. Admissions criteria did not include prognostic considerations.

Interventions: Selected patients were entered into a formal weaning program beginning in 1992.

Measurements: Through the study period, there was a substantial growth in annual admissions, primarily due to increases in patients surviving a catastrophic acute illness. Overall, 107 of 278 (38%) patients were liberated from mechanical ventilation for at least 7 consecutive days and nights. Of the patients admitted 1993 to 1995, 31% died, 20% were discharged to a long-term care facility, 29% returned home, and 18% either remained as residents of the unit or had been transferred to acute-care facilities and were unavailable for follow-up. The highest weaning success was seen in patients with ventilator dependence from postoperative causes (58%) and acute lung injury (57%); the least success was seen in patients with ventilator dependence from COPD and neuromuscular diseases (22% each). The average time from admission to weaning fell within each diagnostic category throughout the study period.

Conclusions: Rehabilitation-based ventilator weaning units play an important role in the spectrum of medical care necessary in population centers. Excellent results can result from community-based units with open admissions policies.


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