title: Initial experience with a mechanical ventilation weaning unit.
abstract: BACKGROUND
  While increasing numbers of patients require prolonged mechanical ventilation, resources for weaning are either limited (ICU beds) or inadequate (general wards).
  
  
  OBJECTIVE
  To report on our initial experience over a 7 month period with an eight-bed mechanical ventilation weaning unit.
  
  
  METHODS
  Sixty-nine patients requiring MV for > 10 days were admitted to the unit (nurse:patient ratio 1:4). Data collected included reason for MV, duration of hospital stay, and MVWU course. Outcome results (successful weaning and mortality) were compared to those in historic controls (patients ventilated in the general wards over a 4 month period prior to the MVWU; n = 100).
  
  
  RESULTS
  The mean age of the patients was 68 +/- 16.6 years and hospital stay prior to MVWU admission 28.6 +/- 24.2 days (range 10-72). The main reasons for MV included acute exacerbation of chronic obstructive pulmonary disease (31%) and recent pneumonia (28%). Mean MVWU stay was 13.5 +/- 15.7 days (range 1-72 days). Thirty-four patients (49%) underwent tracheostomy. Fourteen patients required admission to the ICU due to deterioration in their status. Twenty-nine patients (42%) were successfully weaned and discharged to the wards. A further 20 patients were transferred to the chronic ventilation unit of a regional geriatric rehabilitation hospital, where 5 were subsequently weaned and 15 required prolonged ventilation. Compared to controls (matched for age and reason for mechanical ventilation), more MVWU patients underwent successful weaning (49% vs. 12%, P < 0.001) and their mortality rate (n = 12) was significantly lower (17% vs. 88%, P < 0.001).
  
  
  CONCLUSIONS
  The higher level of care possible in a MVWU may result in a significantly improved rate of weaning and lower mortality. The assessment of long-term outcome in patients discharged to pulmonary rehabilitation centers requires further investigation.
authors.affiliation: General Intensive Care Unit, Rabin Medical Center (Beilinson Campus), Petah Tiqva, Israel.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cohen
authors.forename: Daniel
authors.initials: D
authors.lastname: Starobin
authors.forename: Gregory
authors.initials: G
authors.lastname: Papirov
authors.forename: Maury
authors.initials: M
authors.lastname: Shapiro
authors.forename: Elad
authors.initials: E
authors.lastname: Grozovsky
authors.forename: Mordechai R
authors.initials: MR
authors.lastname: Kramer
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015300:Ventilator Weaning