A proposal of a new model for long-term weaning: respiratory intensive care unit and weaning center.
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.
Carpenè
Nicoletta
N
Cardiothoracic Department, Pulmonary Unit, University Hospital of Pisa, Via Paradisa 2, Cisanello, Pisa, Italy.
Vagheggini
Guido
G
Panait
Eugenia
E
Gabbrielli
Luciano
L
Ambrosino
Nicolino
N
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