To show the effects on outcomes of primary diagnoses and co-morbidities in 157 patients admitted in 2003 to a long-term ventilator support unit with active weaning. Patients were followed until discharge or 3/31/04.
Data were extracted from medical records. Diagnoses requiring long-term ventilator support recorded; burden of illness from co-morbidities calculated using Cumulative Illness Rating Scale (CIRS) which weights and sums impairments in 14 organ systems (0-4;4=maximum organ impairment: range of sums 0-52). Patients were grouped by diagnoses: Neurological (NEURO) n=62; Cardiopulmonary (CP) n=55; Both (n=40); then divided into potentially weanable or unweanable using established criteria. The weanable were subdivided into weaned (four weeks free from ventilator support) and failed. Between-group comparisons were made.
No differences existed between diagnostic groups in gender and CIRS scores. Age differences existed between NEURO and CP groups (60±20 yrs vs 72±15; p < 0.01), Both group (67±20 yrs). More NEURO patients were weanable and weaned. Weanable, NEURO60%(37/62), CP34%(19/55), Both37%(15/40) (p = 0.008): weaned, 78%(29/37), 74%(14/19), 67%(10/15), respectively. The end point level of care differed between diagnostic groups: home or nursing facility (lower level); long term acute care (unchanged level); acute care or death (higher level). NEURO; lower23%(14/62), unchanged29%(18/62), higher48%(30/62). CP; lower13%(7/55), unchanged9%(5/55), higher78%(43/55). Both; lower5%(2/4O), unchanged25%(10/40), higher70%(28/40) (p = 0.001). In the weaned groups, these differences were even more evident. CIRS subgroups scores within groups were significantly different. NEURO; weaned 24.86±5.56, failed 29.37±6.57, unweanable 28.78±4.01 (p = 0.013). CP; weaned 22.28±8.50, failed 25.20±8.79, unweanable 29.06±4.50 (p = 0.0034). Both; weaned 26.10±4.53, failed 28.80±3.27, unweanable 29.71±5.86 (p = 0.21).
Neurological patients were the most weanable. Patients in any diagnostic group, who were weanable had better survival outcomes and greater likelihood of going to a less restrictive level of care. These patients had significantly lower burden of illness from co-morbidities.
Primary diagnostic groups and co-morbidities have major effects on weaning outcomes and survival. These clinical characteristics should be considered in the selection of patients into an active weaning program.
J. Frengley, None.