MECHANICAL VENTILATION

Outcomes, cost and long term survival of patients referred to a regional weaning centre

D V Pilcher¹, M J Bailey², D F Treacher¹, S Hamid³, A J Williams¹, A C Davidson¹

¹ Lane Fox Respiratory Unit, Guy’s and St Thomas’ Hospital, London SE1 7EH, UK
² Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
³ Bromley Hospitals NHS Trust, Bromley, Kent BR6 8ND, UK

Correspondence to:
Correspondence to:
Dr A C Davidson
Lane Fox Respiratory Unit, Guy’s and St Thomas’ Hospital, London SE1 7EH, UK; craig.davidson{at}gstt.sthames.nhs.uk

Background: Regional weaning centres provide cost effective care for patients who have undergone prolonged mechanical ventilation. There are few published European data on outcomes in these patients.

Methods: Patients admitted for weaning to the Lane Fox Respiratory Unit (LFU) between January 1997 and December 2000 were identified. The proportion weaned from mechanical ventilation, in-hospital mortality, and subsequent survival after discharge were examined.

Results: A total of 153 patients had been ventilated for a median of 26 days before transfer. The daily cost per patient stay was 1350. Fifty eight patients (38%) were fully weaned, 42 (27%) died, and 53 (35%) required ventilatory support at discharge from hospital of whom 36 (24%) required only nocturnal ventilation. Univariate analysis showed increasing age (OR 1.06, p<0.001), length of ICU stay (OR 1.02, p = 0.001), APACHE II predicted risk of death score (OR 1.02, p = 0.05), and a surgical cause for admission (OR 4.04) were associated with mortality. Neuromuscular/chest wall conditions were associated with low mortality (OR 0.36) but low likelihood of weaning from ventilation (OR 0.28). Female sex (OR 2.13, p = 0.03) and COPD (OR 2.81) were associated with successful weaning. Overall survival at 3 years from admission was 47%. Long term survival was lowest in patients with COPD.

Conclusions: Most patients survived to leave hospital, the majority having been liberated from ventilatory support. Survivors were younger and spent less time ventilated in the referring ICU. The underlying diagnosis determined success of weaning, hospital survival, and long term outcome.

Keywords: weaning; mechanical ventilation; survival; weaning units

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