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.
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.
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.
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.
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.
D.J. Scheinhorn, None.