Bagley P H, Cooney E
Medical Center of Central Massachusetts, Worcester, USA.
Chest. 1997 Apr;111(4):1024-9. doi: 10.1378/chest.111.4.1024.
Description of the development of a community-based weaning unit and the outcomes from that unit.
Review of admissions, classified by etiology of ventilator dependence, with attention to disposition, length of stay, and time to wean.
Long-term acute-care facility in Worcester, Mass.
Two hundred seventy-eight ventilator-dependent patients admitted to a ventilator unit from 1988 through May 1995. Admissions criteria did not include prognostic considerations.
Selected patients were entered into a formal weaning program beginning in 1992.
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.
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.
描述一个基于社区的撤机单元的发展情况及其相关结果。
回顾按呼吸机依赖病因分类的入院情况，关注出院情况、住院时间和撤机时间。
马萨诸塞州伍斯特的长期急性护理机构。
1988年至1995年5月期间入住呼吸机单元的278名依赖呼吸机的患者。入院标准不包括预后因素。
从1992年开始，选定的患者进入正式的撤机计划。
在研究期间，年入院人数大幅增长，主要是由于灾难性急性疾病存活患者的增加。总体而言，278名患者中有107名（38%）成功脱离机械通气至少连续7个昼夜。在1993年至1995年入院的患者中，31%死亡，20%出院至长期护理机构，29%回家，18%要么仍为该单元的住院患者，要么已转至急性护理机构且无法进行随访。术后原因导致呼吸机依赖的患者（58%）和急性肺损伤患者（57%）撤机成功率最高；慢性阻塞性肺疾病和神经肌肉疾病导致呼吸机依赖的患者撤机成功率最低（均为22%）。在整个研究期间，每个诊断类别从入院到撤机的平均时间保持稳定。
基于康复的呼吸机撤机单元在人口中心所需的医疗服务范围内发挥着重要作用。实行开放入院政策的社区单元可取得优异成果。
