Chest
Volume 120, Issue 6, Supplement, December 2001, Pages 482S-484S
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Post-ICU Weaning From Mechanical Ventilation: The Role of Long-term Facilities

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A review of the largest observational studies on post-ICU weaning from prolonged mechanical ventilation yields evidence that more than half of such patients can be successfully liberated from mechanical ventilation. Success is likely to fall within a 3-month window, with late successes and partial ventilator independence still possible thereafter. There is a uniformity of practice in finishing difficult weaning with self-breathing trials of increasing duration.

Section snippets

Summary Review of Available Evidence

Since to our knowledge there are no reports of such rigorously designed studies, we have reviewed observational studies that report outcomes in > 100 patients and in which, according to the Health Care Financing Administration, PMV is defined as ≥ 21 days of ventilator dependency.4Table 1 characterizes the population served and displays the demographic information and outcomes of those studies, while Table 2 lists the basic weaning strategies that were used in the units from which that

Discussion

Given that both types of units deliver acute care, but that not all provide critical care (ie, ICU) interventions and staffing, they are often dissimilar in admission and discharge criteria, treatment capabilities, and the availability of specialty/subspecialty consultation services and procedures offered on site, all of which likely have a significant effect on the reported outcomes of care. While methodological details are given short shrift in these reports, which focus on outcome not

Conclusion

Although lacking a benchmark, large observational studies have demonstrated success in weaning patients from PMV following ICU treatment for acute illnesses that are usually superimposed on chronic diseases. Depending on community availability, this successful weaning is accomplished in NRCUs or RWCs, which vary in the type of patient admitted but are consistent in the basic approach to weaning. The cost of care in these units is less than that for care in the ICU. Health-care professionals are

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