Outcomes, cost and long term survival of patients referred to a regional weaning centre.
BACKGROUND
Regional weaning centres provide cost effective care for patients who have undergone prolonged mechanical ventilation. There are few published European data on outcomes in these patients.


METHODS
Patients admitted for weaning to the Lane Fox Respiratory Unit (LFU) between January 1997 and December 2000 were identified. The proportion weaned from mechanical ventilation, in-hospital mortality, and subsequent survival after discharge were examined.


RESULTS
A total of 153 patients had been ventilated for a median of 26 days before transfer. The daily cost per patient stay was 1350. Fifty eight patients (38%) were fully weaned, 42 (27%) died, and 53 (35%) required ventilatory support at discharge from hospital of whom 36 (24%) required only nocturnal ventilation. Univariate analysis showed increasing age (OR 1.06, p<0.001), length of ICU stay (OR 1.02, p = 0.001), APACHE II predicted risk of death score (OR 1.02, p = 0.05), and a surgical cause for admission (OR 4.04) were associated with mortality. Neuromuscular/chest wall conditions were associated with low mortality (OR 0.36) but low likelihood of weaning from ventilation (OR 0.28). Female sex (OR 2.13, p = 0.03) and COPD (OR 2.81) were associated with successful weaning. Overall survival at 3 years from admission was 47%. Long term survival was lowest in patients with COPD.


CONCLUSIONS
Most patients survived to leave hospital, the majority having been liberated from ventilatory support. Survivors were younger and spent less time ventilated in the referring ICU. The underlying diagnosis determined success of weaning, hospital survival, and long term outcome.
Pilcher
D V
DV
Lane Fox Respiratory Unit, Guy's and St Thomas' Hospital, London SE1 7EH, UK.
Bailey
M J
MJ
Treacher
D F
DF
Hamid
S
S
Williams
A J
AJ
Davidson
A C
AC
D018806:APACHE; D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000401:mortality* / Q000534:rehabilitation; D012044:Regression Analysis; D012124:Respiratory Care Units / Q000191:economics* / Q000458:organization & administration; D016019:Survival Analysis
Chest. 1997 Apr;111(4):1024-9
9106584
Chest. 1995 Feb;107(2):500-5
7842784
Chest. 1999 Sep;116(3):732-9
10492280
Eur Respir J. 1998 Jun;11(6):1349-53
9657578
Chest. 1989 Nov;96(5):1120-4
2509150
Crit Care. 1997;1(3):101-104
11056702
N Engl J Med. 1995 Sep 28;333(13):817-22
7651472
Crit Care Med. 2000 Feb;28(2):342-50
10708164
Chest. 1997 Jun;111(6):1654-9
9187189
Br J Anaesth. 1995 Oct;75(4):399-404
7488476
Chest. 1995 Feb;107(2):494-9
7842783
Chest. 1996 Oct;110(4):1018-24
8874263
Minn Med. 1991 Apr;74(4):23-7
1908547
Lancet. 2000 Jun 3;355(9219):1931-5
10859037
Am J Respir Crit Care Med. 1999 May;159(5 Pt 1):1568-73
10228128
Ann Intern Med. 1998 May 1;128(9):721-8
9556465
Lancet. 1993 Jun 19;341(8860):1555-7
8099639
Chest. 1999 Aug;116(2):447-55
10453875
JAMA. 1993 Feb 24;269(8):1025-9
8429584
Chest. 1996 Jun;109(6):1591-6
8769516
Mayo Clin Proc. 1997 Jan;72(1):13-9
9005279
Intensive Care Med. 2002 Jul;28(7):908-16
12122529
Intensive Care Med. 1991;17(1):7-10
2037727
Arch Intern Med. 1993 Jul 26;153(14):1657-62
8333803
Am J Crit Care. 1997 Mar;6(2):99-105
9172858
Mayo Clin Proc. 2000 May;75(5):445-9
10807071
Intensive Care Med. 1998 Oct;24(10):1009-17
9840233
JAMA. 2004 Oct 27;292(16):1955-60
15507580