Weaning Unit Research Articles

Differences between prolonged weaning patients from medical and surgical intensive care units

It is not clear whether patients entering a specialized, interdisciplinary weaning unit from surgical or medical intensive care units (ICU) distinguish substantially. The purpose of the present study was to assess differences in patients with prolonged weaning being referred from surgical and medical ICU. Data collected from April 2013 to April 2014 was conducted for retrospective analysis. Mortality rates, demographic data, clinical, and microbial differences in 150 patients with prolonged weaning were assessed (80 surgical and 70 medical). Surgical ICU referrals tended to be older (70.7 ± 11.3 vs. 67.3 ± 12.3, P = 0.051) and had fewer underlying pulmonary diseases (45% vs. 60%, P = 0.067). Sodium values at the time of referral to the weaning unit were significantly higher in surgical (147.1 ± 9.6) vs. medical (141.3 ± 6.7 mmol/l) patients (P < 0.001). Each 10-unit increase in sodium at the time of referral to the weaning unit was associated with a 2.5-day (95% CI -0.4, 5.4; P = 0.09) prolongation of stay in the weaning unit. Although significant differences in microbiological agents from tracheal aspiration were seen, the infection rate on the weaning unit was similar in both groups. There was no difference in weaning unit mortality between surgical and medical ICU patients (18% vs. 23%; P = 0.41). Few differences were found between patients being referred to a specialized weaning unit from surgical vs. medical ICUs. Besides differences in microbiological characteristics of tracheal secretions, there were also differences in sodium levels, which appear to influence on treatment duration.

Weaning ward-different from the ICU?

Weaning from mechanical ventilation is generally not the most urgent topic on many ICUs, because acutely endangered patients are usually the staff's main focus. Nevertheless, even these patients whose underlying problem has been mostly solved-whether it was neurologic, internal or surgical-are in need of astructured weaning strategy. The aim of this weaning "road map" is ventilator independence, decannulation and regaining of muscular strength. Achieving of these aims needs awell-educated team of physicians, nurses, respiratory/physical therapists, logopedists and pychologists. Assessment of patient health status, including respiratory muscle function must be part of the overtaking procedure to be able to focus on the main problem that may be causative for the inability to wean so far. Every weaning unit must be able to organize the future treatment of patients (different ward inside the hospital, rehabilitation) or the transfer into a(ventilated) home care situation.

Preadmission tracheostomy is associated with better outcomes in patients with prolonged mechanical ventilation in the postintensive care respiratory care setting.

Prolonged mechanical ventilation (PMV) is the most common situation where tracheostomy is indicated for intensive care unit (ICU) patients. However, it is unknown if this procedure confers survival benefits on PMV patients in a post-ICU setting. Patients who were admitted to the specialized weaning unit from 2005 to 2008 and received PMV were included in this study. On admission, data pertaining to patient characteristics, physiologic status, and type of artificial airway (tracheostomy vs. no tracheostomy) were obtained. Outcomes of tracheostomized and nontracheostomized patients were evaluated using multivariate Cox proportional hazards and propensity score-matching models. The primary outcome of interest was 1-year survival. A total of 401 patients (mean age 74.4years, 204 male) were identified. In multivariate analyses, higher Acute Physiology and Chronic Health Evaluation II score [hazard ratio (HR)=1.061, 95% confidence interval (CI)=1.016-1.107] and presence of comorbidities, including congestive heart failure (HR=1.562, 95% CI=1.119-2.181), malignancy (HR=1.942, 95% CI=1.306-2.885), and liver cirrhosis (HR=2.373, 95% CI=1.015-5.544), were independently associated with 1-year mortality. An association between having tracheostomy and a better 1-year outcome was observed (HR=0.625, 95% CI=0.453-0.863). The matched cohort study also demonstrated a favorable 1-year survival for tracheostomized patients, and these patients had significantly lower in-hospital mortality (24% vs. 36%, p=0.049) and risk of ventilator-associated pneumonia (10% vs. 20%, p=0.030) than nontracheostomized ones. Preadmission tracheostomy may be associated with better outcomes of PMV patients in a post-ICU respiratory care setting. The findings suggest that this procedure should be recommended before PMV patients are transferred to specialized weaning units.

Activity and analysis of costs in a dedicated weaning centre

To analyse the diagnosis-related characteristics and the costs of treating patients with difficult/prolonged weaning from mechanical ventilation we have undertaken a retrospective observational study. The study has considered all the patients admitted to our weaning unit of a regional Rehabilitation department during 3 consecutive periods since the opening date. Characteristics of the admitted patients and the DRG-related cares delivered have been recorded. A cost analysis has been obtained over time. The number of beds allocated to this unit (from 4 in the 1st period to 6 in the 2nd and 3rd periods) and the number of patients cared for (from 32 to 43 and to 65, respectively) increased over time. In particular, the COPD to non-COPD patient ratio (from 2.2 to 1.3 and to 1.0) and the DRG/patient weight (from 3.0 +/- 0.3 to 3.1 +/- 0.2 and to 3.3 +/- 0.2 point) changed significantly (p < 0.05). The daily reimbursement per patient from the public health care system only slightly increased, whereas the operating margin (reimbursement less costs) per patient significantly improved (from -304, to +17 and +55 Euro/pt/day, respectively, p < 0.05) due to a gradual restriction in the variable costs. Length of stay, mortality rate and weaning rate did not change over time. The weaning centre is a hospital area where economic burdens should be carefully evaluated. Given the actual reimbursement received on a national level for these patients, variable costs might be better spread, thus optimising the burdens without losing out on clinical outcomes.

Cytokine Reduction in the Setting of an ARDS-Associated Inflammatory Response with Multiple Organ Failure.

A 45-year-old male was admitted to our hospital with a small bowel obstruction due to torsion and was immediately scheduled for surgical intervention. At anesthesia induction, the patient aspirated and subsequently developed a severe SIRS with ARDS and multiple organ failure requiring the use of ECMO, CRRT, antibiotics, and low dose steroids. Due to a rapid deterioration in clinical status and a concurrent surge in inflammatory biomarkers, an extracorporeal cytokine adsorber (CytoSorb) was added to the CRRT blood circuit. The combined treatment resulted in a rapid and significant reduction in the levels of circulating inflammatory mediators. This decrease was paralleled by marked clinical stabilization of the patient including a significant improvement in hemodynamic stability and a reduced need for norepinephrine and improved respiratory function as measured by PaO2/FIO2, ventilator parameters, lung mechanics, and indirect measures of capillary leak syndrome. The patient could be discharged to a respiratory weaning unit where successful respiratory weaning could be achieved later on. We attribute the clinical improvement to the rapid control of the hyperinflammatory response and the reduction of inflammatory mediators using a combination of CytoSorb and these other therapies. CytoSorb treatment was safe and well tolerated, with no device-related adverse effects observed.

S2k-Guideline "Prolonged Weaning".

All mechanically ventilated patients must be weaned from the ventilator at some stage. According to an International Consensus Conference the criteria for "prolonged weaning" are fulfilled if patients fail at least 3 weaning attempts (i. e. spontaneous breathing trial, SBT) or require more than 7 days of weaning after the first SBT. This occurs in about 15 - 20 % of patients.Because of the growing number of patients requiring prolonged weaning a German guideline on prolonged weaning has been developed. It is an initiative of the German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., DGP) in cooperation with other societies (see acknowledgement) engaged in the field chaired by the Association of Scientific and Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF).This guideline deals with the definition, epidemiology, weaning categories, underlying pathophysiology, therapeutic strategies, the weaning unit, transition to out-of-hospital ventilation and therapeutic recommendations for end of life care. This short version summarises recommendations on prolonged weaning from the German guideline.

Weaning unit and prolonged mechanical ventilation after critical illness

Patients requiring prolonged mechanical ventilation (PMV) and protracted and weaning after critical illness is rising. The consequences are higher Intensive Care Unit (ICU) costs and length of hospital stay. Weaning Unit (WU) with a multidisciplinary expert team may facilitate weaning and hospital discharge.

Patients characteristics and outcomes of prolonged mechanical ventilation after critical illness transferred to a weaning unit

Recent trends seem to point out that growing numbers of patients requiring prolonged mechanical ventilation (PMV) and protracted weaning after critical illness with eventually account for a large portion of all Intensive Care Unit (ICU) cost and bed occupancy. Specialized Weaning Unit (WU), may facilitate weaning through focused multidisciplinary expert team, but due to considerable variability of interventions and organization outcomes remain unclear.

Long-term survival of critically ill patients treated with prolonged mechanical ventilation: a systematic review and meta-analysis

Prolonged dependence on mechanical ventilation after critical illness is an emerging public health challenge; however, long-term outcomes are incompletely understood. We aimed to systematically analyse long-term survival of critically ill patients treated with prolonged mechanical ventilation. We searched PubMed, CINAHL, and the Cochrane Library between 1988 and Nov 6, 2013, with no language restrictions, for studies on prolonged mechanical ventilation. We included studies of adult populations treated with mechanical ventilation for more than 14 days, who were admitted to a ventilator weaning unit, or who had a tracheostomy for acute respiratory failure. We abstracted data with a standardised collection template and assessed study quality (ie, risk of bias) using a customised Newcastle-Ottawa Scale. We did a stratified analysis based on study setting (eg, acute vs post-acute care hospitals), and used a random-effects model to calculate pooled statistics (proportions with 95% CIs) for all outcomes. We did sensitivity analyses based on study quality (ie, high-quality studies only) and country of origin (USA vs non-USA and USA vs UK). The primary outcome was mortality at 1 year. Secondary outcomes were in-hospital mortality, discharge destination among survivors, successful liberation from mechanical ventilation while in hospital, and mortality at timepoints longer than 1 year. Of 6326 studies identified, 402 underwent full manuscript review, and 124 studies from 16 countries met the inclusion criteria. 39 studies reported mortality at 1 year, which was 59% (95% CI 56-62). Among the 29 high-quality studies, the pooled mortality at 1 year was 62% (95% CI 57-67). Pooled mortality at hospital discharge was 29% (95% CI 26-32). However, only 19% (16-24) were discharged to home and only 50% (47-53) were successfully liberated from mechanical ventilation. For studies in post-acute care hospitals, outcomes were worse in the USA than internationally (mortality at 1 year was 73% [95% CI 67-78] in the USA vs 47% [29-65] in non-USA countries; in-hospital mortality was 31% [26-37] vs 18% [14-24]; and liberation from ventilation was 47% [42-51] vs 63% [59-68]; p<0·0001 for all). Although a high proportion of patients survived to hospital discharge, fewer than half of patients survived beyond 1 year. Future studies should focus on optimum patient selection for prolonged mechanical ventilation and integration of long-term outcome information into clinical decision making. Cooper University Health Care and Cooper Medical School of Rowan University.

Aspiration in a specialised weaning unit--an underestimated problem

This retrospective case series shows that 45 % of patients aspirated straight after removal of the tracheal cannula. The present case series includes 82 patients with long-term mechanical ventilation (LTMV) admitted to a specialised weaning unit. Aspiration was proven after patients sipped water coloured with patent blue V. Colour was detected with a bronchoscope after passing through the tracheostoma and directed toward the VC. The aspiration rate in this study is in good agreement with other reports in the literature.We could find no significant statistical differences concerning age (p = 0.97), gender (47 % vs. 49), number of bronchoscopies (p = 0.91) and comorbidities (p = 0.326) between patients with and without aspiration. The duration of the stay at the ward and the duration of ventilation as well as the parameter Hb at the time of admission (p = 0.566), CO2(p = 0.288/p = 0.716), HCO3 (p = 0.915/p = 0.612) and CRP (p = 0.402/p = 0.523) at the time of admission and discharge also showed no significant differences.The Kaplan Meier curves show a considerable divergence between patients with and without aspiration. However, the Log Rank Test (p = 0.348) and the univariate Cox Regression (HR 1.4, 95 % CI 0.689 - 2.849) were not significant. We believe that this can be attributed to the event rate, which was too low in our collective. This trend to a higher mortality of patients with aspiration might be due to weakness of the respiratory muscles when there is reduced coughing. Proof of aspiration in these patients is only one aspect of a multidimensional problem. Larger, prospective cohort studies are needed to show whether aspiration can serve as a prognostic marker.

Outcomes for difficult-to-wean subjects after cardiac surgery.

The need for prolonged mechanical ventilation (PMV) after cardiac surgery is still a common problem. We hypothesized that subjects who required PMV after a single surgery (either coronary artery bypass grafting or valve surgery) would have better outcomes than those who had experienced both revascularization and valve surgery. We retrospectively analyzed the characteristics and outcomes for patients consecutively admitted to our weaning unit (WU) after cardiac surgery between December 2007 and August 2012. Subjects' data were analyzed according to the number of procedures. Group 1 included subjects who had undergone a single surgery (valvular replacement or myocardial revascularization). Group 2 included subjects who had undergone combined surgery (valvular replacement and myocardial revascularization). Data for PMV subjects who were transferred to the WU for reasons other than cardiac surgery in the same period are also reported. Of 584 PMV subjects admitted, 35 (5.9%, 19 in group 1 and 16 in group 2) were referred after cardiac surgery. At WU admission, group 2 showed significantly more comorbidities and a greater clinical severity than group 1. Compared with group 1, group 2 showed a significantly lower weaning rate (43.7% vs 78.9%, P = .003) and a higher in-hospital mortality (31.3% vs 5.3%, P = .04). The overall 6-month survival for subjects of group 1 was 73.7% compared with 37.5% for subjects in group 2 (P = .02). Adjusting for comorbidities and clinical severity, the difference between the 2 groups did not reach statistical significance for either the weaning rate or the overall 6-month survival. At discharge, health status, as assessed by means of functional independence measure, was significantly better in group 1 than in group 2 (P = .035). These results suggest that patients needing PMV after combined cardiac surgery may suffer worse outcomes than those needing PMV after simple cardiac surgery.

WeanNet: a network of weaning units headed by pneumologists

There is an increase of both prolonged mechanical ventilation (MV) and prolonged weaning from the respirator in the last decade in Germany. Prolonged MV is associated with an increase of morbidity, mortality and costs.The network "WeanNet", which has been founded by the "Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP, German Respiratory Society) connects weaning units headed by pneumologists with special experience in intensive care medicine.The certification of a weaning unit within WeanNet aims at the improvement of treatment quality, outcome and reduction of costs by well defined structures and processes.Based on growing experience the criteria and procedures of the certification process were adjusted in the last years, leading to a higher transparency and acceleration of the process. On this background WeanNet is necessary to improve the communication about prolonged weaning in public health, with insurance companies and associated scientific societies.

Prolonged weaning: From the intensive care unit to home

Weaning is the process of withdrawing mechanical ventilation which starts with the first spontaneous breathing trial (SBT). Based on the degree of difficulty and duration, weaning is classified as simple, difficult and prolonged. Prolonged weaning, which includes patients who fail 3 SBTs or are still on mechanical ventilation 7 days after the first SBT, affects a relatively small fraction of mechanically ventilated ICU patients but these, however, requires disproportionate resources. There are several potential causes which can lead to prolonged weaning. It is nonetheless important to understand the problem from the point of view of each individual patient in order to adopt appropriate treatment and define precise prognosis. An otherwise stable patient who remains on mechanical ventilation will be considered for transfer to a specialized weaning unit (SWU). Though there is not a precise definition, SWU can be considered as highly specialized and protected environments for patients requiring mechanical ventilation despite resolution of the acute disorder. Proper staffing, well defined short-term and long-term goals, attention to psychological and social problems represent key determinants of SWU success. Some patients cannot be weaned, either partly or entirely, and may require long-term home mechanical ventilation. In these cases the logistics relating to caregivers and the equipment must be carefully considered and addressed.

Prolonged weaning: From the intensive care unit to home

Weaning is the process of withdrawing mechanical ventilation which starts with the first spontaneous breathing trial (SBT). Based on the degree of difficulty and duration, weaning is classified as simple, difficult and prolonged. Prolonged weaning, which includes patients who fail 3 SBTs or are still on mechanical ventilation 7 days after the first SBT, affects a relatively small fraction of mechanically ventilated ICU patients but these, however, requires disproportionate resources. There are several potential causes which can lead to prolonged weaning. It is nonetheless important to understand the problem from the point of view of each individual patient in order to adopt appropriate treatment and define precise prognosis. An otherwise stable patient who remains on mechanical ventilation will be considered for transfer to a specialized weaning unit (SWU). Though there is not a precise definition, SWU can be considered as highly specialized and protected environments for patients requiring mechanical ventilation despite resolution of the acute disorder. Proper staffing, well defined short-term and long-term goals, attention to psychological and social problems represent key determinants of SWU success. Some patients cannot be weaned, either partly or entirely, and may require long-term home mechanical ventilation. In these cases the logistics relating to caregivers and the equipment must be carefully considered and addressed.

Prolongiertes Weaning

Mechanical ventilation (MV) is an essential part of modern intensive care medicine. MV is performed in patients with severe respiratory failure caused by insufficiency of the respiratory muscles and/or lung parenchymal disease when/after other treatments, i. e. oxygen, body position, secretion management, medication or non invasive ventilation have failed.In the majority of ICU patients weaning is routine and does not present any problems. Nevertheless 40-50 % of the time during mechanical ventilation is spent on weaning. About 20 % of patients need continued MV despite resolution of the conditions which originally precipitated the need for MV.There maybe a combination of reasons; chronic lung disease, comorbidities, age and conditions acquired in ICU (critical care neuromyopathy, psychological problems). According to an International Consensus Conference the criteria for "prolonged weaning" are fulfilled if patients fail at least three weaning attempts or require more than 7 days of weaning after the first spontaneous breathing trial. Prolonged weaning is a challenge. An inter- and multi-disciplinary approach is essential for weaning success. Complex, difficult to wean patients who fulfill the criteria for "prolonged weaning" can still be successfully weaned in specialised weaning units in about 50% of cases.In patients with unsuccessful weaning, invasive mechanical ventilation has to be arranged either at home or in a long term care facility.This S2-guideline was developed because of the growing number of patients requiring prolonged weaning. It is an initiative of the German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., DGP) in cooperation with other societies engaged in the field.The guideline is based on a systematic literature review of other guidelines, the Cochrane Library and PubMed.The consensus project was chaired by the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) based on a formal interdisciplinary process applying the Delphi-concept. The guideline covers the following topics: Definitions, epidemiology, weaning categories, pathophysiology, the spectrum of treatment strategies, the weaning unit, discharge from hospital on MV and recommendations for end of life decisions. Special issues relating to paediatric patients were considered at the end of each chapter.The target audience for this guideline are intensivists, pneumologists, anesthesiologists, internists, cardiologists, surgeons, neurologists, pediatricians, geriatricians, palliative care clinicians, nurses, physiotherapists, respiratory therapists, ventilator manufacturers.The aim of the guideline is to disseminate current knowledge about prolonged weaning to all interested parties. Because there is a lack of clinical research data in this field the guideline is mainly based on expert opinion.

Impact of feed restriction on health, digestion and faecal microbiota of growing pigs housed in good or poor hygiene conditions

Feed restriction could be a relevant strategy to preserve gut health, reduce systemic inflammatory response and finally limit antibiotic use. This study assessed the effect of feed restriction on growing pigs submitted to a moderate inflammatory challenge induced by the degradation of the environmental hygiene that is known to alter growth rate. The experiment was run on 80 pigs selected at 7 weeks of age according to a 2×2 factorial design: two feeding levels, ad libitum (AL) and feed restricted (FR) at 60% of AL, and two conditions of environmental hygiene, clean and dirty. Pigs were housed individually throughout the experiment. From 61 to 68 days of age (day 0 to 7), pigs were housed in a post weaning unit and feed restriction was applied to half of the pigs from day 0 to day 29. At 68 days of age (day 7 of the experiment), pigs were transferred in a growing unit where half of FR and half of AL pigs were housed in a dirty environment (poor hygiene) and the other half in a clean environment (good hygiene) until day 42. Growth performance was recorded weekly. Blood and faeces samples were collected to measure indicators of inflammation, nutrient digestibility and microbiota composition. Faecal consistency was monitored daily to detect diarrhoeas. Feed restriction decreased daily weight gain (−35% to −50%, P<0.001), increased the feed conversion ratio (+15%, P<0.001) and CP digestibility (+3%, P<0.05) and reduced the occurrence of diarrhoeas irrespective of hygiene conditions. Poor hygiene conditions decreased growth performance (−20%, P<0.05) and total tract digestibility of all nutrients (P<0.001). Haptoglobin (+50%) concentrations and lymphocyte (+10%) and granulocyte (+40%) numbers were higher in poor hygiene conditions (P<0.05), confirming that the model was effective to induce a systemic inflammatory response. Both feed restriction and hygiene modified the profile of the faecal microbiota. In this study, feed restriction did not reduce the systemic inflammatory response caused by poor hygiene conditions despite the limitation of the occurrence of digestive disorders. However, our study opens discussions regarding the impact of hygiene and feed restriction on gut microbial communities and digestive health.

Long-Term Acute Care Patients Weaning From Prolonged Mechanical Ventilation Maintain Circadian Rhythm

Circadian rhythm regulates many physiologic and immunologic processes. Disruption of these processes has been demonstrated in acutely ill, mechanically ventilated patients in the ICU setting. Light has not been studied as an entraining stimulus in the chronically mechanically ventilated patient. The purpose of this study was to determine the association of naturally occurring ambient light levels in a long-term acute care (LTAC) hospital with circadian rhythm in patients recovering from critical illness and requiring prolonged mechanical ventilation (PMV). We performed a prospective observational study of 15 adult patients who were recovering from critical illness and receiving PMV and who were admitted to the ventilator weaning unit at an LTAC hospital. Demographic data were obtained from chart review. Light stimuli in each patient room were assessed using a photometer device placed at eye level. Circadian rhythm was assessed by wrist actigraphy. Cumulative data were obtained from each device for a 48-h period, averaged into 4-h intervals, and analyzed. Patients receiving PMV were obese (mean body mass index of 32.7 ± 10.3 kg/m2) and predominantly female (73%) and had an average age of 63.1 ± 14.3 y. Light exposure to this cohort maintained diurnal variation (P < .001) and was significantly different across time periods. Circadian rhythm, as represented by actigraphy, also maintained diurnal variation (P < .001) and was in phase with light. Linear regression of movement and time demonstrated a moderate relationship between light and actigraphy (R2 = 0.56). Despite requiring continued high-level care and a prolonged stay in a medical facility, patients recovering from critical illness and actively weaning from PMV maintain their circadian rhythm in phase with normal diurnal variations of light.

Inpatient and long‐term outcomes of individuals admitted for weaning from mechanical ventilation at a specialized ventilation weaning unit

Weaning from invasive mechanical ventilation (IMV) in specialized weaning units has been demonstrated to be safe and cost-effective. Success rates and outcomes vary widely, probably relating to patient factors and unit expertise. An audit was undertaken of patients admitted for weaning from IMV at the Austin Hospital Ventilation Weaning Unit (VWU) between March 2002 and January 2008. Weaning success, complications and both in-hospital and long-term mortality were examined and regression analysis was undertaken to examine factors related to these outcomes. Seventy-eight patients were admitted to the VWU after a median of 27 days of IMV at their referring centre. Weaning success rate (ventilator free or nocturnal non-invasive ventilation only) was 78.2% (n = 61). Inpatient mortality was 10.2% (n = 8) and serious complications were infrequent. Progressive neuromuscular disease (odds ratio 0.10) and sepsis during admission to the VWU (odds ratio 0.09) were predictive of weaning failure at discharge. Overall survival at 12 months following discharge from the VWU was 66.7% (n = 52) with most survivors residing in the community. Increasing age (hazard ratio 1.93), referral from rural or outer metropolitan centres (hazard ratio 3.57 and 2.37 respectively) and a diagnosis of chronic obstructive pulmonary disease were associated with increased long-term mortality. High rates of weaning success with infrequent complications and low mortality were achieved in this specialized non-intensive care unit-based weaning unit. The VWU may provide a useful template for the development of similar units elsewhere.

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Introduction: Approximately 40% of patients admitted to critical care units require mechanical ventilation (MV). Volume status and cardiac function have been considered important predictors of weaning among patients in the ICU but have not been studied among patients on prolonged MV. This study was conducted to study the role of volume status and cardiac function (as assessed via echocardiography) as predictors in this population. Hypothesis: Volume status and cardiac function assessed via echocardiogram predict weaning outcomes among patients on prolonged MV. Methods: We conducted a retrospective chart review of all adult patients on prolonged MV admitted to the Respiratory Special Care Unit (ReSCU, a long term weaning unit) at the Cleveland Clinic Hospital from April 2011 through May 2012. Prolonged MV was defined as need for MV for at least 6 hours daily for at least 21 consecutive days. Liberation from MV within 24 hours of admission to the unit and unavailability of echocardiogram in 2 weeks prior to admission or at admission were grounds for exclusion (n=66, mean age 60.8 years, M:F 33:33).Demographic, clinical and laboratory variables on day of admission were recorded. Echocardiogram done at the time of admission to the unit or within the last 2 weeks was reviewed and variables reflective of volume status (such as left atrium size, IVC collapsibility) and right and left ventricular function were recorded. Successful weaning, defined as breathing independent of MV for? 72 consecutive hours, was the primary endpoint. Variables were compared between patients who were weaned versus those who could not be weaned. Results: Caucasians formed the majority of the study group (n=53, 80.3%) followed by African Americans (n=10, 15.2%) Pneumonia was the most common etiology for respiratory failure. 37 patients (56.1%) patients were successfully weaned. Weaned patients were younger (mean age 55 ± 18 vs 68 ± 12 years, p=0.001) and had better nutritional status (mean albumin levels 2.73 ± 0.44 vs 2.42 ± 0.41 g/dL, p=0.005). None of the echocardiographic parameters predicted successful weaning (weaned vs not weaned respectively: left ventricular ejection fraction 56.1 ± 7.6% vs 52.4 ± 10.5%; left atrial enlargement among 40% vs 50%; mean right ventricular systolic pressure 42.3 ± 19.9 vs 41.8 ± 15.2 mm Hg; presence of right ventricular systolic dysfunction among 51.4% vs 41.7%; right ventricular dilatation 45.7% vs 36%; right atrial enlargement 19.4% vs 22.2%; mean inferior vena cava diameter 2.1 ± 0.5 cm vs 2.1 ± 0.4 cm; all P=NS). Conclusions: Most patients requiring prolonged MV can be successfully weaned. Whereas younger age and better nutritional status at baseline favors successful wean, volume status and cardiac function assessed via echocardiogram do not help to prognosticate these patients.

P228 Referral Patterns and Outcomes For Patients Treated in a National Centre Specialising in Weaning From Invasive Mechanical Ventilation

IntroductionWith increasing evidence for the use of non-invasive ventilation (NIV) for acute COPD1, a change in referral pattern to a national weaning unit was anticipated over time. We investigated the...