Chest
Volume 131, Issue 1, January 2007, Pages 85-93
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Original Research: Chronic Critical Illness
Post-ICU Mechanical Ventilation at 23 Long-term Care Hospitals: A Multicenter Outcomes Study

https://doi.org/10.1378/chest.06-1081Get rights and content

Abstract

Study objectives:This multicenter study was undertaken to characterize the population of ventilator-dependent patients admitted to long-term care hospitals (LTCHs) with weaning programs, and to report treatments, complications, weaning outcome, discharge disposition, and survival in these patients.

Design:Observational study with concurrent data collection.

Setting:Twenty-three LTCHs in the United States.

Patients:Consecutive ventilator-dependent patients admitted over a 1-year period: March 1, 2002, to February 28, 2003.

Results:A total of 1,419 patients were enrolled in the Ventilation Outcomes Study. Median age of patients was 71.8 years (range, 18 to 97.7 years). Patients averaged 6.9 procedures and treatments during the LTCH hospitalization; median length of stay was 40 days (range, 1 to 365 days). Seven of the 10 most frequent complications treated at the LTCH were infections; congestive heart failure and diabetes mellitus were the most common comorbidities requiring treatment. Outcomes of weaning attempts, scored at LTCH discharge, were 54.1% weaned, 20.9% ventilator dependent, and 25.0% deceased. Median time to wean (n = 766) was 15 days (range, 7 to 30 days). Discharge disposition included 28.8% to home, 49.2% to rehabilitation and extended-care facilities, and 19.5% to short-stay acute hospitals. Nearly one third of patients were known to be alive 12 months after admission to the LTCH.

Conclusions:Patients admitted to LTCHs for weaning attempts were elderly, with acute-on-chronic diseases, and continued to require considerable medical interventions and treatments. The frequency and type of complications were not surprising following prolonged and aggressive ICU interventions. In the continuum of critical care medicine, more than half of ventilator-dependent survivors of catastrophic illness transferred from the ICU were successfully weaned from prolonged mechanical ventilation in the setting of an LTCH.

Section snippets

Materials and Methods

A detailed description of the Ventilation Outcomes Study regarding facility recruitment, investigator training, investigational review board (IRB) approval, and data collection and submission processes has been published.4Briefly, a series of surveys of NALTH-member hospitals yielded 23 sites for study participation. The study design was an observational, quality assurance study, with concurrent data collection. Consecutive adult patients receiving invasive mechanical ventilation admitted to

Results

Between March 1, 2002, and February 28, 2003, 23 LTCHs with weaning programs admitted 1,587 ventilator-dependent patients, enrolling 1,419 patients after 168 exclusions. Characteristics and status of enrolled patients on LTCH admission are shown inTable 1.

Discharge data sets were submitted for 1,414 of 1,419 patients (99.6%) enrolled. The frequency of selected procedures, services, and treatments received by patients during the LTCH stay are listed inTable 2. All patients received multiple

Discussion

Ours is the first multicenter study to report weaning outcomes of ventilator-dependent survivors of catastrophic illness transferred to the post-ICU setting of LTCHs. In this continuum of critical care medicine, more than half of the patients were discharged weaned from mechanical ventilation. Strengths of the current study are that consecutive patients receiving mechanical ventilation were enrolled from 23 different LTCHs, employing uniform definitions of weaning outcomes. More than 30

Expert Panel

David C. Chao, MD, Oak Bend Medical Center, Richmond, TX; Gordon S. Doig, PhD, Institute for International Health, University of Sydney, Sydney, Australia; Scott K. Epstein, MD, Department of Medicine, Tufts University School of Medicine, Boston, MA; E. Bert Knight, MD, Spartanburg Hospital for Restorative Care, Spartanburg, SC; Richard A. Petrak, MD, RML Specialty Hospital, Hinsdale, IL; Ellen A. Pitt, MD; David J. Scheinhorn, MD, Barlow Respiratory Hospital and Research Center, Los Angeles,

Acknowledgments

We thank Karen Slovin, BA, for Web site design and database services. We also thank M. Jillisa Steckart, MEd, PsyD, for analysis and interpretation of selected data in this study.

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This work was performed at Barlow Respiratory Hospital and Research Center, Los Angeles, CA. This study was supported in part by the NALTH and the Norris Foundation. The authors have no conflicts of interest to disclose.

For the Ventilation Outcomes Study Group. A list of participants is given in the Appendix.

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