title: Prospective observational cohort study of patients with weaning failure admitted to a specialist weaning, rehabilitation and home mechanical ventilation centre.
abstract: OBJECTIVE
  According to National Health Service England (NHSE) specialist respiratory commissioning specification for complex home ventilation, patients with weaning failure should be referred to a specialist centre. However, there are limited data reporting the clinical outcomes from such centres.
  
  
  METHODS
  Prospective observational cohort study of patients admitted to a UK specialist weaning, rehabilitation and home mechanical ventilation centre between February 2005 and July 2013.
  
  
  METHODS
  262 patients admitted with a median age of 64.2 years (IQR 52.6-73.2 years). 59.9% were male.
  
  
  RESULTS
  39.7% of patients had neuromuscular and/or chest wall disease, 21% were postsurgical, 19.5% had chronic obstructive pulmonary disease (COPD), 5.3% had obesity-related respiratory failure and 14.5% had other diagnoses. 64.1% of patients were successfully weaned, with 38.2% weaned fully from ventilation, 24% weaned to nocturnal non-invasive ventilation (NIV), 1.9% weaned to nocturnal NIV with intermittent NIV during the daytime. 21.4% of patients were discharged on long-term tracheostomy ventilation. The obesity-related respiratory failure group were most likely to wean (relative risk (RR) for weaning success=1.48, 95% CI 1.35 to 1.77; p<0.001), but otherwise weaning success rates did not significantly vary by diagnostic group. The median time-to-wean was 19 days (IQR 9-33) and the median duration of stay was 31 days (IQR 16-50), with no difference observed between the groups. Weaning centre mortality was 14.5%, highest in the COPD group (RR=2.15, 95% CI 1.19 to 3.91, p=0.012) and lowest in the neuromuscular and/or chest wall disease group (RR=0.34, 95% CI 0.16 to 0.75, p=0.007). Of all patients discharged alive, survival was 71.7% at 6 months and 61.8% at 12 months postdischarge.
  
  
  CONCLUSIONS
  Following NHSE guidance, patients with weaning delay and failure should be considered for transfer to a specialist centre where available, which can demonstrate favourable short-term and long-term clinical outcomes.
authors.affiliation: Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Denise
authors.initials: D
authors.lastname: Mifsud Bonnici
authors.affiliation: Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Sanctuary
authors.affiliation: GKT School of Medical Education, King's College London, London, UK.
authors.forename: Alex
authors.identifier: http://orcid.org/0000-0002-9622-8354
authors.initials: A
authors.lastname: Warren
authors.affiliation: Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Murphy
authors.affiliation: Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK Faculty of Life Sciences and Medicine, King's College London, London, UK.
authors.forename: Joerg
authors.initials: J
authors.lastname: Steier
authors.affiliation: Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Marino
authors.affiliation: Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Hina
authors.initials: H
authors.lastname: Pattani
authors.affiliation: Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK Intensive Care Unit, Royal Surrey County Hospital, Guildford, Surrey, UK Surrey Perioperative Anaesthesia and Critical care collaborative research group (SPACeR), Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK.
authors.forename: Ben C
authors.initials: BC
authors.lastname: Creagh-Brown
authors.affiliation: Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK Faculty of Life Sciences and Medicine, King's College London, London, UK Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hart
mesh_terms: D000368:Aged; D004739:England; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality*; D012121:Respiration, Artificial / Q000401:mortality*; D012131:Respiratory Insufficiency / Q000453:epidemiology*; D015300:Ventilator Weaning / Q000706:statistics & numerical data*
keywords: THORACIC MEDICINE