PURPOSE: Long-term acute care units (LTACs) are designed to meet the needs of patients who have ventilator-dependent respiratory failure, chronic pulmonary problems, complex and severe wounds, infections requiring long term antibiotic therapy, and conditions requiring continued life support, nutritional therapies, or pain control. The population of patients requiring prolonged mechanical ventilation (PMV) has been a rising area of research and study since the 1990s, when emerging economic pressures to maximize resource utilization have resulted in specialized centers for post intensive care unit (ICU) care. Optimal weaning strategies have been proposed and investigated.
METHODS: The weaning protocol used in our setting is derived from that used by Sheinhorn and Chao. The main modifications are as follows (compare Appendices): (1) Initial Ventilator settings that specify low tidal volumes (consistent with ARDSNet trial data) (2) Included additional steps for initial assessment; portable chest x-ray, ABGs, weaning parameter daily. Decisions regarding the plan of care are then made according to findings. This model has been in place for the last three years. Constant communication between all members of the multidisciplinary team facilitates weaning.
RESULTS: One hundred and nine with different comorbidities as shown in (graph 1). Forty six patients (46) admitted on a ventilator in 2007 were successfully weaned (n=109). This reflects a wean success rate of 46%. Mortality rate was 28.28%. 8% reventilated as of this preliminary report, data on patient demographics, time to wean was 14.5 days, and rate of ICU transfer is 15.6% as shown in (graph 2).
CONCLUSION: The weaning success rate of ventilated patients admitted to our LTAC is 46%. With median time to wean 14.5 days without any exclusion with different comorbidities is numerically better than most reported data on wean-success rates using the modified-TIPS protocol.
CLINICAL IMPLICATIONS: Controlled, cohort studies should be undertaken to study this evolving segment of hospital care, to elucidate whether the use of a multi-disciplinary weaning team or the use of this modified-TIPS protocol indeed provides a statistical difference in wean outcomes or mortality.
DISCLOSURE: Abdul Hamid Alraiyes, No Financial Disclosure Information; No Product/Research Disclosure Information