title: Effects of a multidisciplinary care program on disability, autonomy, and nursing needs in subjects recovering from acute respiratory failure in a chronic ventilator facility.
abstract: BACKGROUND
  The aim of this study was to analyze the effects of a multidisciplinary program carried out in a chronic ventilator facility on disability, autonomy, and nursing needs of patients after a prolonged ICU stay. Secondary outcome measures were survival, weaning rate, chronic ventilator facility stay, and discharge destination.
  
  
  METHODS
  Multidisciplinary assessment, clinical stabilization, weaning attempts, and a new Disabled Patients Autonomy Planning tool to assess daily care needs were investigated in 240 subjects in a chronic ventilator facility (52 subjects after cardiovascular surgery, 60 subjects with acute respiratory failure, 71 subjects with COPD, and 57 subjects with neurological disease).
  
  
  RESULTS
  At admission, nursing needs, disability, and autonomy differed according to diagnosis (P < .001); weaned subjects had greater nursing needs (P < .001) and disability (P = .0014) than unweaned subjects. During the stay, 13.8% of the subjects died irrespective of diagnosis (P = .12); 47% (P < .001) were weaned with significant differences (P <.007) by diagnosis. In the 207 surviving subjects, nursing needs increased as disability increased (r = 0.59, P < .001) and autonomy decreased (r = -0.66, P < .001); disability and autonomy were inter-related (r = 0.61, P < .001). Oxygen saturation, hypercapnia, dyspnea, disability, autonomy, and nursing needs significantly improved (all, P < .001). Fifty-nine percent of the subjects were discharged home. Subjects discharged to nursing homes presented mainly neurological diseases, being more disabled and less autonomous, with higher nursing needs (all, P < .04). Mechanical ventilation use and tracheostomy increased the probability of being discharged to a nursing home (odds ratio [OR] of 1.84, P = .04; OR 2.47, P = .003, respectively). Mortality was higher in subjects who were ventilated (OR 8.44, P < .001), male (OR 2.64, P = .01), elderly (P < .001), or malnourished (P = .01) and in subjects with low autonomy (P < .001), greater nursing needs (P = .002), and more severe disabilities (P = .04).
  
  
  CONCLUSIONS
  A specialized tailored multidisciplinary program in subjects after an ICU stay contributed to recovery from disability, autonomy, and fewer nursing needs irrespective of diagnosis. Subjects discharged to a nursing home were the most severely disabled.
authors.affiliation: Divisione di Pneumologia Riabilitativa michele.vitacca@fsm.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Vitacca
authors.affiliation: Divisione di Pneumologia Riabilitativa.
authors.forename: Mara
authors.initials: M
authors.lastname: Paneroni
authors.affiliation: Divisione di Cardiologia Riabilitativa.
authors.forename: Roberta
authors.initials: R
authors.lastname: Peroni
authors.affiliation: Divisione di Pneumologia Riabilitativa.
authors.forename: Luca
authors.initials: L
authors.lastname: Barbano
authors.affiliation: Divisione di Pneumologia Riabilitativa.
authors.forename: Valmira
authors.initials: V
authors.lastname: Dodaj
authors.affiliation: Divisione di Pneumologia Riabilitativa, Fondazione Salvatore Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Pavia, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Piaggi
authors.affiliation: Divisione di Neurologia Riabilitativa, Fondazione Salvatore Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Lumezzane (Brescia), Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Vanoglio
authors.affiliation: Divisione di Neurologia Riabilitativa, Fondazione Salvatore Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Lumezzane (Brescia), Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Luisa
authors.affiliation: Divisione di Cardiologia Riabilitativa.
authors.forename: Amerigo
authors.initials: A
authors.lastname: Giordano
authors.affiliation: Divisione di Pneumologia Riabilitativa, Fondazione Salvatore Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Pavia, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Ceriana
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000628:therapy; D008875:Middle Aged; D020380:Needs Assessment; D009422:Nervous System Diseases / Q000150:complications / Q000451:nursing; D009735:Nursing Homes; D009752:Nutritional Status; D010348:Patient Care Team; D010351:Patient Discharge; D026684:Personal Autonomy; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000451:nursing*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012737:Sex Factors; D015996:Survival Rate; D014139:Tracheostomy / Q000451:nursing; D015300:Ventilator Weaning / Q000451:nursing
keywords: COPD; chronic care facilities; long-term hospital; post-surgical; prolonged mechanical ventilation; weaning