To compare pre-morbid functional status to that at admission, discharge, and 12-months post-admission, for patients transferred to Barlow Respiratory Hospital (BRH), a long term acute care hospital (LTAC), for weaning from prolonged mechanical ventilation (PMV).
Data were collected as part of an observational multicenter study with a 1-year enrollment period. Initial datasets were collected at BRH admission; weaning outcome was scored at discharge. Telephone contact was used to determine 12-month post-admission functional status. Functional status was determined using the Zubrod Score (0 = Fully active to 4 = Bedridden with no self-care). Zubrod scores of 0-2 were determined to be good functional status; scores of 3-4 were poor functional status. Discharge Zubrod was not scored for patients who died.
186 patients were enrolled from 3/1/02 - 2/28/03. Patients’ age: 74 [22-98] years. Patients spent 32 [1-216] days at the transferring facility, with 31[1-215] days of mechanical ventilation. Total days of hospitalization (transferring facility + BRH): 70 [8-388] days. Interactive with staff on admission: 66%. Weaning outcome: 49% weaned, 22% remained ventilator-dependent, 29% died; 23% of survivors were discharged directly home. There was no significant difference in weaning outcome between patients with good premorbid functional status and those with poor premorbid functional status. Patient functional status at selected time points: Pre-morbid (n=180): 66.1% good, 33.9% poor; BRH admission (n=186): 0% good, 100% poor; BRH discharge (n=116): 11.2% good, 88.8% poor; 12-months post BRH admission (n=48): 43.8 % good, 56.2% poor.
Patients admitted to BRH were elderly, but largely independent before their catastrophic illnesses and PMV. Functional status at discharge in the surviving 71% of patients was less than pre-morbid, but improved from that at transfer to BRH. At 12-months post-admission to BRH, nearly half of survivors reported good functional status.
Functional status falls to expected lows in an elderly population with PMV following a catastrophic illness. Gains in functional status are demonstrated as long as 12-months post-admission to an LTAC specializing in weaning from PMV.
D.J. Scheinhorn, None.