PURPOSE: The goal of this program is to improve patient and family outcomes by aggressive respiratory care in a specialized long term ventilator unit.
METHODS: We opened a skilled nursing level ventilator program with full time respiratory therapist staffing. We received 42 referrals from eleven health care facilities in a 220-mile radius in a three year period. Patients were screened with a pre-admission screening system. 27 patients qualified for admission to the unit.
RESULTS: Admitted patients average age was 65.7 years; 33% male, 67% female. Thirty-three percent of patients were discharged successfully, average age 60 years, 33% male, 67% female. The average length of time to discharge was 150.5 days.The disposition on discharge was: one discharged home on nocturnal ventilation, two discharged off mechanical ventilation and decannulated to an assisted living facility, and six discharged to their home residence without ventilation assistance or tracheostomy.The average tidal volume on admission was 6 ml/kg. We had better T-piece spontaneous breathing trials when the patients were rested on 10–12 ml/kg tidal volumes. Trach collar trials were 75% more likely to lead to success than pressure support weaning attempts. The use of a speaking valve lead to improved effort by the patient in the weaning attempts. Patients admitted averaged an inspired oxygen level of 44% with an average oxygen saturation of 95%. We found improved tolerance of trach collar trials and lung function after two weeks of allowing lower oxygen saturations (87%–88%). The major deterent to successful weaning was the balance of anxiety control versus sedation levels.Thirty-seven percent of the patients expired on the service; several of this group were converted to hospice services. The average age of this group was 79.2 years; average length of service days were 102.6 days. The male to female ratio was 50:50.
CONCLUSION: With appropriate care, many long term ventilator patients were successfully weaned and returned to their homes.
CLINICAL IMPLICATIONS: A respiratory therapist staffed long term ventilator unit can have a positive effect on outcome.
DISCLOSURE: Skip Bangley, No Financial Disclosure Information; No Product/Research Disclosure Information