Critical Care: Mechanical Ventilation & Respiratory Failure II |

Chronic Critical Illness: Influence of Etiology of Ventilator Dependency on Weaning Outcomes at a Regional Weaning Center FREE TO VIEW

Meg Hassenpflug, MS; Jillisa Steckart, MEd; David Nelson, MD
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Barlow Respiratory Hospital, Los Angeles, CA

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

Chest. 2016;150(4_S):323A. doi:10.1016/j.chest.2016.08.336
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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 serving as a regional weaning center, accepting chronically critically ill (CCI) patients transferred from the ICUs of hospitals in southern California. Our first published observational outcomes study reported etiology of ventilator dependency in 421 patients admitted for weaning from 1988-1991 (Chest 1994; 105:534-39). Herein we revisit those data and report updates to etiologies of ventilator dependency, and patient characteristics on admission with weaning outcomes from our Ventilation Outcomes Database (VOD), a performance improvement database.

METHODS: Descriptive study of patients admitted to the Ventilator Weaning Program. VOD was queried for selected admission characteristics and outcomes of patients discharged 10/1/2014-12/31/2015. Outcomes (weaned, ventilator-dependent, died) were scored at discharge; weaned defined as patient free of invasive mechanical ventilation for at least one full calendar day prior to day of discharge. Etiology of ventilator dependency (diagnosis leading to initial ICU admission) was determined as per methodology in previous report with six classifications: acute lung disease, chronic lung disease, post-operative, cardiac disease, neurologic disease, and other. Percent of patients in those six categories were compared to historical data from 1988-1991 cohort. Admission characteristics and weaning outcomes for patients in the most recent cohort are reported across the categories.

RESULTS: From 10/1/2014-12/31/2015, 337 patients admitted for weaning were discharged from the Ventilator Weaning Program. Comparison of etiologies of most recent cohort of 337 patients to 421 patients in historical cohort: acute lung disease 39% vs 32%; chronic lung disease 7% vs 25%; post-operative 18% vs 24%; cardiac disease 12% vs 5%; neurologic disease 14% vs 8%; other 12% vs 7%. Weaning success rate reported as n (%) for each category in recent cohort: acute lung disease 67 (53); chronic lung disease 9 (38), post-operative 37 (62); cardiac 18 (46); neurologic 30 (65); other 25 (61). Of patients with acute lung disease etiologies, 31% also had underlying chronic lung disease.

CONCLUSIONS: Separated by nearly 25 years, there is a striking but perhaps not surprising shift in the etiologies of ventilator dependency in post-ICU mechanical ventilation between these two cohorts, possibly attributable in part to advances in medical technology. Across the categories, patients with chronic lung disease etiologies weaned at a lower rate. Wean rates over 60% for post-operative, neurologic, and other categories could be related to lower incidence of underlying lung disease.

CLINICAL IMPLICATIONS: Identification of differences in patient outcomes related to etiologies of ventilator dependency, with consideration of reversible vs irreversible disease, may provide opportunities to inform treatment decisions, trajectories of care, and resource utilization. Of interest is an emerging concept of “persistent critical illness” in patients with CCI, a new direction for investigation that may possibly inform continued ventilator dependency in relation to a cascade of critical illnesses and ongoing complications rather than the original ICU admission diagnosis.

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

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