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Variables Associated With Weaning From Mechanical Ventilation in Patients Admitted to a Long-Term Acute Care Hospital (LTACH). FREE TO VIEW

Michael Martinez; Jennifer Dixon; Frans van Wagenberg; Ying Fang; Cecilia Benz; Alejandro C Arroliga; Shekhar Ghamande; David Ciceri
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Baylor Scott & White Health, Temple, TX

Chest. 2014;146(4_MeetingAbstracts):904A. doi:10.1378/chest.1994964
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SESSION TITLE: Respiratory Support Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Historically 33-50% of patients requiring long-term ventilation are eventually liberated from invasive mechanical ventilation (MV). Prognostication is crucial in this population. We report variables associated with failure to wean from MV.

METHODS: We retrospectively examined data on 184 consecutive patients on mechanical ventilation admitted to our LTACH for ventilator management from 2011 to 2012. A standardized protocol for ventilator weaning, nutrition and mobilization was used for all patients. Successful weaning from the ventilator was defined as being free from any mechanical ventilatory assistance for 5 days. Two-sample t tests and Wilcoxon Two-sample tests were used to compare continuous variables. Chi-square test or Fisher’s exact test were used for categorical variables (p < 0.05 indicated a statistical significance).

RESULTS: 75.4% of patients were liberated from mechanical ventilation. The LTACH mortality was 14.7% (27 of 184). Variables associated with failure to wean were: older age (67.8yrs old [+/- 14.6] vs 61.9yrs old [+/- 16.0] p=0.0109), a primary medical diagnosis (57.2% vs 42.8% p=0.0231), a history of COPD (51.1% vs 25.4% p=0.0013), acute renal failure (> AKIN II) (55.6% vs 26.8% p=000.4), and myocardial infarction during hospitalization (20% vs 8.7% p=0.0388). 18.8% of weaned patients were discharged directly home with 39.9% going to a skilled nursing facility, 29.7% to an inpatient rehabilitation facility, 3.6% to hospice and 2.2% to the ICU. Failure to wean imparted a 14 fold increased mortality at 1 month (OR 14.23, 6.39-31.71, p<0.0001).

CONCLUSIONS: We report a higher weaning success rate compared with historic studies. Increased age, COPD, renal failure, and MI impact liberation from MV.

CLINICAL IMPLICATIONS: Incorporating certain variables may allow practitioners to stratify weaning potential in selected patient populations.

DISCLOSURE: The following authors have nothing to disclose: Michael Martinez, Jennifer Dixon, Frans van Wagenberg, Ying Fang, Cecilia Benz, Alejandro C Arroliga, Shekhar Ghamande, David Ciceri

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