Outcomes of Patients after Discharge from the Respiratory Care Center

Abstract

Background: Since little attention has been given to the long-term outcomes of patients in hospital-based ventilator weaning units, we sought to evaluate the outcomes of patients discharged from the Respiratory Care Center (RCC) in a university medical center in southern Taiwan. Methods: A prospective data collection was performed with the patients who were admitted to the RCC during a 3-year period, from December2001 to December 2004. These data included age, gender, underlying disease, total ventilator days, ICU and RCC stay days, ICU and RCC ventilator days, hospital discharge status, and disposition. Long-term outcomes after discharge from the RCC were ascertained using a review of hospital medical records and/or direct inquiry of patients and/or family members through telephone interviews. Results: Totally, 240 prolonged mechanical ventilator-dependent (≥21 days) patients were admitted to the RCC during the study period. Sixty-eight patients (28.3%) were unsuccessfully weaned, and transferred to the RCW, and 133 patients (55.4%) were successfully weaned from the ventilator and left the RCC; the overall hospital mortality rate was 16.3% (39 patients). The weaning rates for the 3 periods of RCC stay were: early weaning (within 14 days) at a rate of 26. 7%, mid-term weaning (15-28 days) at a rate of 33.3%, and late weaning (＞28 days) at a rate of 16.7%. Those patients who stayed in the RCC for more than 28 days had a statistically significantly lower rate of successful weaning. The Kaplan-Meier (KM) survival curve estimates of 240 patients after discharge from the RCC were as follows: 1 month, 70% (95% confidence interval [CI], 65% to 75%); 3 months, 58% (52% to 66%), 6 months, 54% (46% to 62%); 1 year, 43% (36% to 50%); 2 years, 35% (28% to 43%). The KM survival estimates of the unsuccessfully weaned patients after discharge were performed, and there were significant differences in the outcomes of these 2 groups. Within the group of 133 successfully weaned patients, those who underwent early, mid-term, and late successful weaning did not differ in their outcomes, including survival rate and the ventilator-independent rate, after discharge from the RCC. Conclusion: About half of the patients were successfully weaned at our RCC. Patients discharged from the RCC had poorer outcomes if they were ventilator-dependent. And, early or late ventilator weaning in the RCC did not have an impact on the long-term survival or ventilator-independence of the patients.