title: A proposal of a new model for long-term weaning: respiratory intensive care unit and weaning center.
abstract: BACKGROUND
  Respiratory intermediate care units (RICU) are hospital locations to treat acute and acute on chronic respiratory failure. Dedicated weaning centers (WC) are facilities for long-term weaning.
  
  
  OBJECTIVE
  We propose and describe the initial results of a long-term weaning model consisting of sequential activity of a RICU and a WC.
  
  
  METHODS
  We retrospectively analysed characteristics and outcome of tracheostomised difficult-to wean patients admitted to a RICU and, when necessary, to a dedicated WC along a 18-month period.
  
  
  RESULTS
  Since February 2008 to November 2009, 49 tracheostomised difficult-to wean patients were transferred from ICUs to a University-Hospital RICU after a mean ICU length of stay (LOS) of 32.6 +/- 26.6 days. The weaning success rate in RICU was 67.3% with a mean LOS of 16.6 +/- 10.9 days. Five patients (10.2%) died either in the RICU or after being transferred to ICU, 10 (20.4%) failed weaning and were transferred to a dedicated WC where 6 of them (60%) were weaned. One of these patients was discharged from WC needing invasive mechanical ventilation for less than 12h, 2 died in the WC, 1 was transferred to a ICU. The overall weaning success rate of the model was 79.6%, with 16.3% and 4.8% in-hospital and 3-month mortality respectively. The model resulted in an overall 39 845 +/- 22 578 euro mean cost saving per patient compared to ICU.
  
  
  CONCLUSIONS
  The sequential activity of a RICU and a WC resulted in additive weaning success rate of difficult-to wean patients. The cost-benefit ratio of the program warrants prospective investigations.
authors.affiliation: Cardiothoracic Department, Pulmonary Unit, University Hospital of Pisa, Via Paradisa 2, Cisanello, Pisa, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Carpenè
authors.forename: Guido
authors.initials: G
authors.lastname: Vagheggini
authors.forename: Eugenia
authors.initials: E
authors.lastname: Panait
authors.forename: Luciano
authors.initials: L
authors.lastname: Gabbrielli
authors.forename: Nicolino
authors.initials: N
authors.lastname: Ambrosino
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007558:Italy; D007902:Length of Stay / Q000191:economics*; D008297:Male; D018803:Models, Economic; D017063:Outcome Assessment, Health Care; D012131:Respiratory Insufficiency / Q000191:economics* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D014139:Tracheostomy / Q000401:mortality; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000191:economics* / Q000401:mortality / Q000592:standards