2001 OPEN FORUM Abstracts
LONG-TERM FOLLOW-UPOF PATIENTS IN A HOSPITAL-BASED WEANING UNIT.
Richard D. Rice,B.S., RRT, James K. Stoller, M.D. The Cleveland Clinic Foundation, Cleveland,Ohio.
Background: Because littleattention has been given to long-term outcomes of patients in hospital-basedventilator weaning units, we undertook this assessment of outcomes of patientsdischarged from the Respiratory Special Care Unit(ReSCU) of the Cleveland Clinic Hospital. Specifically, the current observationalstudy evaluates the 5-year survival rates and disposition status of patientscared for in our ReSCU between August 22, 1993 and June 1, 1996.
Methods: The ReSCU consistsof 6 private beds on a pulmonary specialty ward. Features of the unit includenon-invasive monitoring (e.g., continuous pulse oximetry, end-title capnometry,and ventilator alarms) with signal output at each bedside and at a central monitoringstation. The unit is staffed by nurses with specific pulmonary rehabilitationexpertise and 24-hour respiratory therapy supervision. Ongoing prospective datacollection in the ReSCU includes monitoring weaning success, demographic features,hospital discharge status, and discharge disposition. Long-term outcomes wereascertained using review of hospital medical records and direct inquiry.
Results: In this interim studyreport, we establish 5-year outcomes for 80% of the 124 unique patients in thiscohort. Between August 22, 1993 and June 1, 1996, 150 individuals were admittedto the ReSCU, 6 repeatedly on separate hospital admissions. Seventeen percent(n=26) died during hospitalization, while 83% were discharged from the indexhospitalization. Of these 124 hospital survivors, 5-year outcome year statusis currently known for 80% (n=99), the remaining data still being sought inthis ongoing study. Of the patients discharged, 11% (n=14) were known to havedied within 1 month, while 47% (n=58) died within 1 year. Cumulative mortalityrates were: 2 years 56% (n=70), 3 years 63% (n=78), 4 years 68% (n=84), and5 years 73% (n=90). Five-year mortality rates considered by year of ReSCU admissionwere for 1993 82%, for 1994 76%, for 1995 78%, and for 1996 52%. Of the patientsalready weaned at the time of hospital discharge (n=94), 72% (n=68) died within5 years.
Conclusion: 1. In this populationrequiring prolonged inpatient ventilatory support, moderately high acute mortalityrates are consistent with other series and are in keeping these patients? highseverity of illness. 2. In this as yet incomplete analysis of longer-term follow-uprates, 5-year survival rates are low, with progressively increasing mortalityin successive 1-year follow-up intervals. 3. At the same time, it must be recognizedthat the current incompleteness of follow-up rates may introduce bias into thisanalysis, depending on the vital status of patients whose follow-up status remainsunknown. Ongoing efforts are directed at ascertaining complete follow-up ofthis cohort.