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Abstract: Slide Presentations |

Post-ICU Mechanical Ventilation: Treatment of 2,369 Patients Over 16 Years at a Regional Weaning Center FREE TO VIEW

Meg Hassenpflug, MS, RD; David J. Scheinhorn, MD*; David C. Chao, MD; Chris Palma, MPH
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Barlow Respiratory Hospital and Research Center, Los Angeles, CA


Chest


Chest. 2004;126(4_MeetingAbstracts):750S-a-751S. doi:10.1378/chest.126.4_MeetingAbstracts.750S-a
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Abstract

PURPOSE:  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.

METHODS:  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.

RESULTS:  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.

CONCLUSION:  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.

CLINICAL IMPLICATIONS:  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.

DISCLOSURE:  D.J. Scheinhorn, None.

Tuesday, October 26, 2004

12:30 PM- 2:00 PM


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