Post-ICU mechanical ventilation at 23 long-term care hospitals: a multicenter outcomes study.
OBJECTIVE
This multicenter study was undertaken to characterize the population of ventilator-dependent patients admitted to long-term care hospitals (LTCHs) with weaning programs, and to report treatments, complications, weaning outcome, discharge disposition, and survival in these patients.


METHODS
Observational study with concurrent data collection.


METHODS
Twenty-three LTCHs in the United States.


METHODS
Consecutive ventilator-dependent patients admitted over a 1-year period: March 1, 2002, to February 28, 2003.


RESULTS
A total of 1,419 patients were enrolled in the Ventilation Outcomes Study. Median age of patients was 71.8 years (range, 18 to 97.7 years). Patients averaged 6.9 procedures and treatments during the LTCH hospitalization; median length of stay was 40 days (range, 1 to 365 days). Seven of the 10 most frequent complications treated at the LTCH were infections; congestive heart failure and diabetes mellitus were the most common comorbidities requiring treatment. Outcomes of weaning attempts, scored at LTCH discharge, were 54.1% weaned, 20.9% ventilator dependent, and 25.0% deceased. Median time to wean (n = 766) was 15 days (range, 7 to 30 days). Discharge disposition included 28.8% to home, 49.2% to rehabilitation and extended-care facilities, and 19.5% to short-stay acute hospitals. Nearly one third of patients were known to be alive 12 months after admission to the LTCH.


CONCLUSIONS
Patients admitted to LTCHs for weaning attempts were elderly, with acute-on-chronic diseases, and continued to require considerable medical interventions and treatments. The frequency and type of complications were not surprising following prolonged and aggressive ICU interventions. In the continuum of critical care medicine, more than half of ventilator-dependent survivors of catastrophic illness transferred from the ICU were successfully weaned from prolonged mechanical ventilation in the setting of an LTCH.
Scheinhorn
David J
DJ
Barlow Respiratory Hospital and Research Center, 2000 Stadium Way, Los Angeles, CA 90026, USA.
Hassenpflug
Meg Stearn
MS
Votto
John J
JJ
Chao
David C
DC
Epstein
Scott K
SK
Doig
Gordon S
GS
Knight
E Bert
EB
Petrak
Richard A
RA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D016896:Treatment Outcome; D014481:United States; D015300:Ventilator Weaning / Q000009:adverse effects