Survival of mechanically ventilated patients admitted to a specialised weaning centre.
OBJECTIVE
Hospital mortality and survival rates of long-term ventilated patients.DESIGN. Retrospective cohort study.


METHODS
Specialised national weaning centre.


METHODS
Protocol-directed liberation from ventilator.


METHODS
Four hundred three of 640 patients with prolonged mechanical ventilation (MV) who were admitted to our respiratory intensive care unit (RICU) were studied. MV lasted longer than 2 weeks and patients had failed more than two weaning trials in the referring ICUs. The majority of patients (59.3%) had chronic obstructive pulmonary disease (COPD).


RESULTS
After a mean duration of 41 days of MV prior to transfer, 68% of patients were liberated from the ventilator. In total, 98 of 403 patients (24.3%) died during the stay in our hospital, 305 patients (75.7%) were discharged. Compared to the non-survivors, the survivors were characterised by younger age, longer length of stay in our RICU, lower severity of illness scores at admission, fewer cardiac illnesses and a higher rate of weaning success. In 31.5% of the discharged patients non-invasive MV (NIV) was initiated during the stay at our unit. We gathered follow-up data on 293 patients (96.1%). Post-discharge survival rates were 67.6% at 3 months, 49.4% at 1 year and 38.1% at 3 years. Length of survival was significantly dependent on age, weaning success and main diagnosis (i.e., prognosis in COPD is worse compared to thoracic restriction, neuromuscular disease and others) in the multivariate analysis.


CONCLUSIONS
Difficult-to-wean patients have a high hospital mortality rate and poor long-term prognosis. Age, main diagnosis, severity of illness, weaning success and institution of NIV predict survival.
Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, 57392 Schmallenberg, Germany. Bernd_Schoenhofer@yahoo.com
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B
Schönhofer
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Euteneuer
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S
Nava
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Suchi
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Köhler
D000368:Aged; D002985:Clinical Protocols; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D012124:Respiratory Care Units / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D015300:Ventilator Weaning