To report population characteristics and preliminary weaning outcome data from a multicenter study of ventilator-dependent patients transferred to long term hospitals (LTHs) for continued weaning from prolonged mechanical ventilation (PMV).
De-identified data were submitted via secure web site for this observational study with a 1-year enrollment period. Initial datasets were collected from the first 3 days of LTH admission; weaning outcomes were scored at LTH discharge. Data were collected by trained study coordinators.
1,411 patients from 23 LTHs with weaning programs were enrolled from 3/1/02 – 2/28/03. Patients’ age: 72 [18–100] years. Premorbid findings: 87% came from home or assisted living where 88% were ambulatory and capable of self care; underlying illnesses included: COPD 43%, heart disease 54%, neurological disease 20%. Patients spent 27 [0–274] days at the transferring facility, with 25 [0–273] days of mechanical ventilation. PMV was precipitated by surgery in 39%. On LTH admission: 97% were tracheotomized, 87% were bedridden and fully disabled, 70% were able to follow commands, 41% had stage II or higher pressure ulceration, 26% had multiple ulcers; APACHE®III APS = 36 [4–115]. Mean number of procedures and services received: 5 per patient. Mean number of complications and comorbidities requiring treatment: 2.1 and 2.5 per patient, respectively. Preliminary weaning outcomes (n=1,088): 54.1% weaned, 20.3% ventilator-dependent, and 25.6% died; 30% of survivors were discharged directly home.CONCLUSIONS: Patients transferred to LTHs for weaning attempts are elderly, with acute on chronic disease, and continue to require considerable medical interventions and treatments. Preliminary results show that three-fourths survive to discharge, with 73% of survivors weaned. The great majority resides at home before their catastrophic illness where they are largely independent, with one-third of survivors returning directly home from the LTH.CLINICAL IMPLICATION: In the continuum of critical care medicine, more than half of ventilator-dependent survivors of catastrophic illness transferred from the ICU can be successfully weaned from PMV in the setting of the LTH.
D.J. Scheinhorn, None.