Critical Care: Mechanical Ventilation & Respiratory Failure II |

Chronic Critical Illness: Updates to Patient Admission Characteristics and Weaning Outcomes at a Regional Weaning Center FREE TO VIEW

Meg Hassenpflug, MS; Jillisa Steckart, MEd; David Nelson, MD
Author and Funding Information

Barlow Respiratory Hospital, Los Angeles, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):314A. doi:10.1016/j.chest.2016.08.327
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SESSION TITLE: Mechanical Ventilation & Respiratory Failure II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Barlow Respiratory Hospital (BRH) is a 105-bed long-term acute care (LTAC) hospital network that serves as a regional weaning center, accepting chronically critically ill (CCI) patients transferred from the ICUs of hospitals in southern California. Herein we report updates to patient characteristics, weaning outcomes, and discharge disposition from our Ventilation Outcomes Database (VOD), a performance improvement database. We also compare outcomes before and after implementation of our revised Therapist-Implemented Patient-Specific (TIPS©) weaning protocol.

METHODS: Descriptive report of patients admitted to the Ventilator Weaning Program. The VOD was queried for selected patient admission characteristics and outcomes. Outcomes (weaned, ventilator-dependent, died) were scored at BRH discharge; weaned was defined as patient being free of invasive mechanical ventilation for at least one full calendar day prior to day of discharge. Time to wean (days) was tallied from day of admission through last day of ventilator support. Premorbid functional status was determined by the Zubrod Score (0 = Fully active to 4 = Bedridden with no self-care). Zubrod scores of 0-2 were deemed “good” functional status; scores of 3-4 were “poor” functional status. Weaning outcomes are presented in aggregate as well as divided by time period to show the impact of the revised TIPS© weaning protocol. The revised protocol was initiated in 3/2014.

RESULTS: From 1/1/2013-12/31/2015, 838 patients admitted for weaning were discharged from BRH. On admission: age 73 [19-101] years, 54% male, 67% Caucasian, premorbid location home 69%, premorbid function “good” 63%, APS III 42 [7-99], length of stay (LOS) transferring facility 22 [1-384] days, pressue ulcer ≥ stage II 54%, multiple pressure ulcers 22%, hemodialysis 11%. Outcomes: 56% weaned, 34% ventilator-dependent, 9% died; days to wean 14 [1-102], LOS 32 [1-412] days. Disposition: 7% home, 77% rehab/subacute/skilled nursing facilities, 16% short-term acute care hospitals. Comparison of 383 patients discharged 1/2013-3/2014 and 455 patients discharged 4/2014-12/2015: days to wean 17 [1-102] vs 12 [2-55] and LOS 34 [2-294] vs 30 [1-412] respectively (p ≤ .001 for both); weaning outcomes were unchanged.

CONCLUSIONS: This reports admission characteristics, weaning outcomes, and discharge disposition of patients transferred from ICUs to the post-acute care venue of an LTAC hospital. Over 90% of all patients admitted for weaning were discharged alive after approximately eight weeks of prolonged severe illness between the acute care ICU and BRH. More than half of CCI patients admitted to BRH were weaned at discharge. The revised weaning protocol resulted in significant reduction in days to wean and LOS.

CLINICAL IMPLICATIONS: Fewer days on mechanical ventilation may translate to less risk of ventilator-associated events, enhanced rehabilitation opportunities, and shorter LOS. As more patients survive the ICU experience to become chronically critically ill, and more survive to discharge from the LTAC hospital, determination of patient location, frequency of care transitions, ventilator status, long-term survival, quality of life, and functional status become increasingly important considerations and challenges for all stakeholders.

DISCLOSURE: The following authors have nothing to disclose: Meg Hassenpflug, Jillisa Steckart, David Nelson

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