[Withdrawal from the respirator (weaning) in long-term ventilation. The results in patients in a weaning center].
OBJECTIVE
Patients subjected to an increased load and with a decreased capacity of their respiratory muscles may be difficult to wean from mechanical ventilation. Using a weaning strategy with a focus on unloading respiratory muscles may be successful even after long-term mechanical ventilation. In a prospective uncontrolled study, we examined the outcome of our weaning protocol.


METHODS
Under prolonged mechanical ventilation in outlying intensive care units (44.3 +/- 38.1 days) 232 patients (64.8 +/- 12.7 years, 149 males, 83 females) with the following underlying diagnoses were investigated: chronic obstructive pulmonary disease (54.3%), neuromuscular diseases (16%), thoracic restriction (10.8%), chronic left heart failure (7.3%), postsurgical ventilatory failure (6.9%) and miscellaneous conditions (4.7%). Our weaning strategy was focused on type of mechanical ventilation, endotracheal tubes, non-invasive interface, oxygen supply and transport capacity, body position and home mechanical ventilation, if an increased load or a decreased capacity of the respiratory muscles remained after weaning.


RESULTS
Altogether 65% of the patients (n = 152) were weaned in a mean duration of 7.5 days. Intermittent home mechanical ventilation followed in 45 patients (19.4%). In our hospital died 64 patients (27.6%). After a stay of 19.7 +/- 12.2 days in our hospital 72.4% of the patients (n = 168) were discharged. The postdischarge 3-month mortality of the cohort was 36.5%.


CONCLUSIONS
Applying our weaning strategy about 65% of the patients requiring long-term mechanical ventilation were successfully weaned. Weaning was achieved in approximately one fifth of the time previously spent on mechanical ventilation. However, the 3-month mortality of the investigated cohort was 36.3%.
Schönhofer
B
B
Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, Krankenhaus Kloster Grafschaft. Bernd.Schoenhofer@t-online.de
Haidl
P
P
Kemper
P
P
Köhler
D
D
D000368:Aged; D003422:Critical Care; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data