Abstract
BackgroundApproximately ten percent of patients placed on mechanical ventilation during acute illness will require long-term ventilator support. Unfortunately, despite rehabilitation, some will never be liberated from the ventilator. A method of predicting weaning outcomes for these patients could help conserve resources and minimize frustrating failed weaning attempts for this population. The objective of this investigation was to identify predictors of weaning outcome for patients admitted to a chronic ventilator unit (CVU).MethodsThis was a retrospective analysis with prospective validation. The study setting was a 25 bed CVU within a rehabilitation hospital. The training group consisted of 43 patients referred to our facility for weaning after > 3 weeks of mechanical ventilation. A multivariate model to predict weaning outcome was constructed in this group and applied to a prospective group of 31 patients followed during an 18-month period.ResultsA modified Glasgow Coma Scale (GCS) and the presence of sustained spontaneous respirations (SSR), defined as the presence of 2 breaths recorded above the ventilator settings on four occasions, were highly predictive of weaning success within six months of CVU admission. Patients with a modified GCS ≥ 8 were 6.5 times more likely to wean than those with a modified GCS < 8 (95% confidence interval 1.6–26.3) and those with SSR were 25.5 times more likely to wean than those without SSR (95% confidence interval 4.3–51.9).ConclusionsIn our population of CVU patients, simple parameters that were available on admission and did not directly reflect cardiopulmonary function were useful predictors of weaning outcome.
Highlights
Ten percent of patients placed on mechanical ventilation during acute illness will require long-term ventilator support
Setting The study was conducted in a 25-bed chronic ventilator unit (CVU), which is part of university affiliated chronic care hospital staffed by a team of pulmonologists, internists, nurses, respiratory therapists and rehabilitation specialists, including a medical director who is a pulmonologist
This study suggests that a modified Glasgow Coma Scale (GCS) and the presence of spontaneous respirations (SSR) are useful predictors of weaning for selected patients admitted to a CVU
Summary
Ten percent of patients placed on mechanical ventilation during acute illness will require long-term ventilator support. A method of predicting weaning outcomes for these patients could help conserve resources and minimize frustrating failed weaning attempts for this population. The objective of this investigation was to identify predictors of weaning outcome for patients admitted to a chronic ventilator unit (CVU). The number of acutely ill hospitalized patients placed on mechanical ventilation has increased over the past 20 years, perhaps by as much as 50% per decade. [1] Many of these patients are elderly or have multiple medical problems, and as a result, often need prolonged periods of rehabilitation prior to successful weaning from mechanical ventilation. While only 5–10% of patients require more than 3 weeks of ventilator support, these patients consume 35–50% of intensive care resources. [2]
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