Weaning İçin Pulmoner Rehabilitasyon Programı içeren Yeni Bir Model

Abstract

INTRODUCTION: Our chronic respiratory failure service where we manage the patients with acute /chronic respiratory failure, is a hospital unit with multidisciplinary team with structured integrated pulmonary rehabilitation (PR) and home care unit. The aim of the study was to present our weaning experiences of inpatient hospital service in patients with prolonged mechanical ventilation (MV) and whether multidisciplinary structured inpatient service model could be an alternative method for weaning. METHODS: Twenty-three patients with home invasive mechanical ventilation (IMV) who underwent multidisciplinary inpatient PR program and weaning trials were analyzed. Dyspnea scores, body composition, respiratory muscle strength, physicological status, echocardiagraphic measurements before PR and weaning process, duration of IMV (since the opening of the tracheostomy), ABG levels before and 24 hours after weaning were recorded. RESULTS: One patient was with pneumonia, 13 with COPD, 5 with bronchiectasis, 2 with kyphoscoliosis, and 2 with congestive heart failure. The median value of duration of IMV was 126 days. The weaning trial was performed on 15 of 21 patients. Six patients were not found to be appropriate for weaning. 12 of 15 patients were decannulated with 80% weaning success. Four patients were discharged with long term oxygen therapy (LTOT), nocturnal non-IMV, 7 with LTOT, and 1 without device. The patients with weaning failure had higher anxiety depression scores, systolic pulmonary arterial pressures, lower maximum inspiratory, expiratory pressures, and shorter duration of IMV. DISCUSSION AND CONCLUSION: This study showed that chronic respiratory failure inpatients services consisting of multidisciplinary team and integrating PR into patients’ managements could serve as weaning centers in case of absence of specialized centers in prolonged MV.