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Clinical Investigations in Critical CareA Community-Based Regional Ventilator Weaning Unit: Development and Outcomes
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.