Chest
Volume 124, Issue 5, November 2003, Pages 1892-1899
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Clinical Investigations in Critical Care
Long-term Outcomes for Patients Discharged From a Long-term Hospital-Based Weaning Unit*

https://doi.org/10.1378/chest.124.5.1892Get rights and content

Background

Because little attention has been given to the long-term outcomes of patients in hospital-based ventilator weaning units, we undertook this assessment of 5-year outcomes of patients discharged from the Respiratory Special Care Unit (ReSCU) of the Cleveland Clinic Hospital.

Methods

The ReSCU consists of six private beds on a pulmonary specialty ward. Features of the unit include noninvasive monitoring with signal output at each bedside and at a central monitoring station. The unit is staffed by nurses with specific pulmonary rehabilitation expertise and has 24-h respiratory therapist supervision. Ongoing prospective data collection in the ReSCU includes monitoring weaning success, demographic features, hospital discharge status, and hospital discharge disposition. Long-term outcomes were ascertained using a review of hospital medical records and direct inquiry to patients and/or family members.

Results

Between August 22, 1993, and August 22, 1996, 162 individuals were admitted to the ReSCU, with 7 persons having repeat admissions during separate hospital admissions. Seventeen percent of these persons (n = 27) died during the hospitalization, while 83% were discharged from the index hospitalization (ie, the hospital stay during which the patient was first admitted to the ReSCU). Kaplan-Meier (KM) mortality rate estimates were as follows: 1 month, 11% (95% confidence interval [CI], 6 to 15%); 1 year, 57% (95% CI, 49 to 65%); 2 years, 68% (95% CI, 61 to 75%); 3 years, 73% (95% CI, 66 to 80%); 4 years, 76% (95% CI, 69 to 83%); and 5 years, 81% (95% CI, 75 to 87%). The 5-year KM mortality rate estimates considered by year of ReSCU admission were as follows: 1993, 92% (95% CI, 77 to 100%); 1994, 84% (95% CI, 73 to 95%); 1995, 87% (95% CI, 77 to 96%); and through August 22, 1996, 66% (95% CI, 51 to 81%).

Conclusions

In this population requiring prolonged inpatient ventilatory support, moderately high acute mortality rates are consistent with data from other series. In this analysis of longer-term follow-up rates, the 5-year survival rates are low, with higher mortality rates within the first 2 years and a slower decline in survival thereafter.

Section snippets

Materials and Methods

Features of the ReSCU include the following: (1) six private beds on a pulmonary specialty ward staffed by nurses with special pulmonary and rehabilitation expertise; (2) 24-h respiratory therapist supervision; (3) noninvasive monitoring (ie, continuous pulse oximetry, end-tidal capnometry [CO2SMO model 7100; Novametrix Medical Systems; Wallingford, CT], and ventilator alarms) with signal output at each bedside and at a central monitoring station (Patient Care Monitoring System; Spacelabs

Results

Between August 22, 1993 and August 22, 1996, 162 patients were admitted to the ReSCU. As shown in Table 1, 59% of the cohort were women, and the mean age was 65 years. The causes of respiratory failure leading to mechanical ventilation and need for ReSCU among the 162 patients included the following: (1) COPD (13 patients; 8%); (2) ARDS, with or without multiple organ failure in a nonsurgical patient (47 patients; 29%); (3) ARDS with multiple organ failure in a surgical patient (31 patients;

Discussion

In this description of long-term survival in patients in a hospital-based weaning unit, our main findings were as follows:

  • 1.

    In keeping with the results of the few available earlier reports,456789 rates of 5-year survival among patients admitted to our hospital-based weaning unit were low.

  • 2.

    The pattern of postdischarge survival rate shows steep declines within the first 2 years (32%) with slower decline thereafter (5-year survival rate, 19%).

  • 3.

    Survival rates for the patient cohort admitted to

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