Chest
Volume 111, Issue 4, April 1997, Pages 1024-1029
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Clinical Investigations in Critical Care
A Community-Based Regional Ventilator Weaning Unit: Development and Outcomes

https://doi.org/10.1378/chest.111.4.1024Get rights and content

Study objective

Description of the development of a community-based weaning unit and the outcomes from that unit.

Design

Review of admissions, classified by etiology of ventilator dependence, with attention to disposition, length of stay, and time to wean.

Setting

Long-term acute-care facility in Worcester, Mass.

Patients

Two hundred seventy-eight ventilator-dependent patients admitted to a ventilator unit from 1988 through May 1995. Admissions criteria did not include prognostic considerations.

Interventions

Selected patients were entered into a formal weaning program beginning in 1992.

Measurements

Through the study period, there was a substantial growth in annual admissions, primarily due to increases in patients surviving a catastrophic acute illness. Overall, 107 of 278 (38%) patients were liberated from mechanical ventilation for at least 7 consecutive days and nights. Of the patients admitted 1993 to 1995, 31% died, 20% were discharged to a long-term care facility, 29% returned home, and 18% either remained as residents of the unit or had been transferred to acute-care facilities and were unavailable for follow-up. The highest weaning success was seen in patients with ventilator dependence from postoperative causes (58%) and acute lung injury (57%); the least success was seen in patients with ventilator dependence from COPD and neuromuscular diseases (22% each). The average time from admission to weaning fell within each diagnostic category throughout the study period.

Conclusions

Rehabilitation-based ventilator weaning units play an important role in the spectrum of medical care necessary in population centers. Excellent results can result from community-based units with open admissions policies.

Section snippets

Materials and Methods

Unit admission and discharge records were reviewed. The study group included all patients admitted to the unit through May 31, 1995. The data collected included patient identification and demographic information, etiology of ventilator dependency, dates of admission, wean, and discharge, as well as the disposition. Disposition information was collected through March 31, 1996. Cost information was supplied by the Fairlawn Rehabilitation Hospital.

The admitting pulmonologist classified patients as

Results

Two hundred seventy-eight ventilator-dependent patients were admitted to the unit from January 1,

1988 to May 15, 1995. Table 2 details the demographic data of the entire group and the cohort admitted since the move from the original site. The LOS decreased from 188 to 77 days, reflecting the move away from providing residential care.

Table 3 illustrates how the etiology of ventilator dependence of the patients admitted to the unit has changed with time. In the first 3 years covered by this

Discussion

Several investigators have noted that with a rehabilitation-focused approach, large percentages of previously “unweanable” ventilator-dependent patients could be liberated from the ventilator.1, 2, 3, 4, 5 We also found high success rates using this approach. We believe the best approach to the care of these individuals involves optimizing functional abilities, rather than simply liberating an individual from the ventilator. The rehabilitation model of care seems appropriate for this goal.

In

Acknowledgments

The work presented in this article represents the efforts of many individuals other than the authors. Special thanks are due Drs. Joel Seidman, Steven Davis, Vesantha Shekar, and Kyu Kim, all of whom participated in the care of the patients discussed in this article.

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Peter H. Bagley is on the salaried staff of the Medical Center of Central Massachusetts, which receives income from Fairlawn Rehabilitation Hospital for his services as Medical Director of the ventilator unit described in this article. Elaine Cooney has no financial interests in the material discussed in this manuscript.

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