0
Clinical Investigations in Critical Care |

Long-term Outcomes for Patients Discharged From a Long-term Hospital-Based Weaning Unit*

James K. Stoller; Meng Xu; Edward Mascha; Richard Rice
Author and Funding Information

*From the Departments of Pulmonary and Critical Care Medicine (Dr. Stoller and Messrs. Xu and Rice), and Biostatistics and Epidemiology (Mr. Mascha), Cleveland Clinic Foundation, Cleveland, OH.

Correspondence to: James K. Stoller, MD, MS, FCCP, Department of Pulmonary and Critical Care Medicine, A 90, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195; e-mail: stollej@ccf.org



Chest. 2003;124(5):1892-1899. doi:10.1378/chest.124.5.1892
Text Size: A A A
Published online

Background: Because little attention has been given to the long-term outcomes of patients in hospital-based ventilator weaning units, we undertook this assessment of 5-year outcomes of patients discharged from the Respiratory Special Care Unit (ReSCU) of the Cleveland Clinic Hospital.

Methods: The ReSCU consists of six private beds on a pulmonary specialty ward. Features of the unit include noninvasive monitoring with signal output at each bedside and at a central monitoring station. The unit is staffed by nurses with specific pulmonary rehabilitation expertise and has 24-h respiratory therapist supervision. Ongoing prospective data collection in the ReSCU includes monitoring weaning success, demographic features, hospital discharge status, and hospital discharge disposition. Long-term outcomes were ascertained using a review of hospital medical records and direct inquiry to patients and/or family members.

Results: Between August 22, 1993, and August 22, 1996, 162 individuals were admitted to the ReSCU, with 7 persons having repeat admissions during separate hospital admissions. Seventeen percent of these persons (n = 27) died during the hospitalization, while 83% were discharged from the index hospitalization (ie, the hospital stay during which the patient was first admitted to the ReSCU). Kaplan-Meier (KM) mortality rate estimates were as follows: 1 month, 11% (95% confidence interval [CI], 6 to 15%); 1 year, 57% (95% CI, 49 to 65%); 2 years, 68% (95% CI, 61 to 75%); 3 years, 73% (95% CI, 66 to 80%); 4 years, 76% (95% CI, 69 to 83%); and 5 years, 81% (95% CI, 75 to 87%). The 5-year KM mortality rate estimates considered by year of ReSCU admission were as follows: 1993, 92% (95% CI, 77 to 100%); 1994, 84% (95% CI, 73 to 95%); 1995, 87% (95% CI, 77 to 96%); and through August 22, 1996, 66% (95% CI, 51 to 81%).

Conclusions: In this population requiring prolonged inpatient ventilatory support, moderately high acute mortality rates are consistent with data from other series. In this analysis of longer-term follow-up rates, the 5-year survival rates are low, with higher mortality rates within the first 2 years and a slower decline in survival thereafter.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543