Chest
Post-ICU Weaning From Mechanical Ventilation: The Role of Long-term Facilities
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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Cited by (51)
Tracheotomy and high-flow oxygen therapy for mechanical ventilation weaning
2017, Revue des Maladies RespiratoiresLong-Term Mechanical Ventilation
2016, Clinics in Chest MedicineCitation Excerpt :Rigorous assessment of these patients has been hindered by the lack of standard definitions for what constitutes ventilator dependency. Throughout the literature and even within governmental regulatory bodies, such as the Centers for Medicare and Medicaid Services (CMS), the definition of PMV varies substantially from the number of days on mechanical ventilation (ranging from 2 to 29 days), the need for mechanical ventilation after leaving the ICU, or simply the need for tracheostomy with 96 or more hours of mechanical ventilation.7–11 The 1998 American College of Chest Physicians Consensus Conference proposed that ventilator-assisted individuals were those with indications for mechanical ventilation beyond the ICU including persistent symptomatic respiratory insufficiency without failure to tolerate or improve with noninvasive ventilation, uncontrollable airway secretions, impaired swallowing leading to chronic aspiration and repeated pneumonias, or severely weakened or paralyzed respiratory muscles.12
Clinical model for predicting prolonged mechanical ventilation
2013, Journal of Critical CareCitation Excerpt :Prolonged mechanical ventilation increases the risk for complications and is often difficult to predict. Approximately 5% to 25% of all mixed ICU patients acutely requiring mechanical ventilation (MV) will remain intubated for more than 5 days, and 3% to 14% will require PMV, typically described as more than 14 or more than 21 days of MV support [2-9]. The prevalence of PMV among a pure medical ICU (MICU) population has not been well defined but is likely more common.
Medical Device-Associated Infections in the Long-Term Care Setting
2012, Infectious Disease Clinics of North AmericaCitation Excerpt :Weaning and eventual decannulation have the greatest impact on reducing an individual patient’s future risk of infection, although this is not feasible in many. Therapist-driven protocols have been shown to shorten the time taken to wean from the mechanical ventilator in the ICU setting, but a more individualized approach may be required in weaning patients after prolonged mechanical ventilation.109 Novel approaches for reducing the risk of tracheostomy infections have been explored on a limited basis.
Chronic critical Illness: A review for surgeons
2011, Current Problems in SurgeryPredictors of successful weaning from prolonged mechanical ventilation in Taiwan
2009, Respiratory MedicineCitation Excerpt :Our findings are comparable to these findings and those of several other studies.3,4,6,15–17 Indeed, in a study that examined post-ICU MV at 23 long-term care facilities, Scheinhorn et al. reported an overall weaning success rate of 52% and a survival to discharge rate of 67%.9 MacIntyre et al. noted that weaning success rates vary from 50% to 94% depending on the study.1