2003 OPEN FORUM Abstracts
VENTILATION AT LONG TERM HOSPITALS:
A MULTICENTER OUTCOMES STUDY
David J. Scheinhorn, M.D., David C. Chao, M.D., Meg Stearn-Hassenpflug, MS, R.D.,
Gordon S. Doig, Ph.D., Scott K. Epstein, M.D., Bert Knight, M.D., Richard A.
M.D., Ellen A. Pitt, M.D., John J. Votto, D.O., for the Ventilation Outcomes
Study Group. Barlow Respiratory Research Center, Los Angeles, CA
PURPOSE: To report population characteristics and preliminary weaning outcome data from a multicenter study of ventilator-dependent patients transferred to long term hospitals (LTHs) for continued weaning from prolonged mechanical ventilation (PMV).
Methods: De-identified data were submitted via secure web site for this observational study with a 1-year enrollment period. Initial datasets were collected from the first 3 days of LTH admission; weaning outcomes were scored at LTH discharge. Data were collected by trained study coordinators. Sixteen of 23 study coordinators (70%) were respiratory care practitioners (RCPs).
RESULTS: 1,411 patients from 23 LTHs with weaning programs were enrolled from 3/1/02 - 2/28/03. Patients' age: 72 [18-100] years. Premorbid findings: 87% came from home or assisted living where 88% were ambulatory and capable of self care; underlying illnesses included: COPD 43%, heart disease 54%, neurological disease 20%. Patients spent 27 [0-274] days at the transferring facility, with 25 [0-273] days of mechanical ventilation. PMV was precipitated by surgery in 39%. On LTH admission: 97% were tracheotomized, 87% were bedridden and fully disabled, 70% were able to follow commands, 41% had stage II or higher pressure ulceration, 26% had multiple ulcers; APACHE®III APS = 36 [4-115]. Mean number of procedures and services received: 5 per patient. Mean number of complications and comorbidities requiring treatment: 2.1 and 2.5 per patient, respectively. Preliminary weaning outcomes (n=1,088): 54.1% weaned, 20.3% remained ventilator-dependent, and 25.6% died; 30% of survivors were discharged directly home.
Conclusions: Patients transferred to LTHs for weaning attempts are elderly, with acute on chronic disease, and continue to require considerable medical interventions and treatments. Preliminary results show that three-fourths survive to discharge, with 73% of survivors weaned. The great majority resides at home before their catastrophic illness, where they are largely independent, with one-third of survivors returning directly home from the LTH. In the continuum of critical care medicine, more than half of ventilator-dependent survivors of catastrophic illness transferred from the ICU can be successfully weaned from PMV in the setting of the LTH.
Supported in part by The National Association of Long Term Hospitals.