A community-based regional ventilator weaning unit: development and outcomes.

STUDY OBJECTIVE

Description of the development of a community-based weaning unit and the outcomes from that unit.

DESIGN

Review of admissions, classified by etiology of ventilator dependence, with attention to disposition, length of stay, and time to wean.

SETTING

Long-term acute-care facility in Worcester, Mass.

PATIENTS

Two hundred seventy-eight ventilator-dependent patients admitted to a ventilator unit from 1988 through May 1995. Admissions criteria did not include prognostic considerations.

INTERVENTIONS

Selected patients were entered into a formal weaning program beginning in 1992.

MEASUREMENTS

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.

CONCLUSIONS

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.