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

Peter H. Bagley; Elaine Cooney
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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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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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