Introduction Data on outcome of the patients referred to weaning and rehabilitation centres are limited. In this observational cohort study, we report the outcomes of patients referred to a specialist complex home ventilation, weaning and rehabilitation centre.
Methods Data from the LFRU database from February 2005 to February 2011 were analysed. The primary diagnosis causing prolonged mechanical ventilation (MV) were classified into five groups: (1) neuromuscular and chest wall disease (NMD-CWD); (2) chronic obstructive pulmonary disease (COPD); (3) post-surgical patients; (4) obesity related respiratory failure (ORRF); and (5) other causes. The principal outcomes measured were weaning success, hospital mortality, 1-year and 2-year survival following discharge.
Results A total of 369 patients were referred over the 6 year period. Of these, 194 (52.6%) were admitted. The commonest outcome was total liberation from all forms of MV (45%). The remainder were shown to (1) require nocturnal non-invasive ventilation (NIV) (22%); (2) require nocturnal and intermittent daytime NIV (1%); (3) require long-term tracheostomy ventilation (24%); and (4) died in hospital (8%). Post-surgical and COPD patients had the highest rate of total liberation from mechanical ventilation at 60% and 54%, respectively. The median time from admission to tracheostomy decannulation was 18 days (9–33). NMD-CWD patients had the lowest hospital mortality (7%), whereas COPD patients had the highest hospital mortality (29%). The overall survival at 12 and 24 months was 60% and 50%, respectively. 25% of the COPD patients were alive and 59% of the NMD-CWD patients were alive at 24 months (Figure 1).
Conclusions The majority of patients with weaning failure were successfully liberated from mechanical ventilation. The weaning time was less than 3 weeks and only one-fifth of patients required nocturnal non-invasive ventilation. NMD-CWD patients were most likely to survive hospital but almost one-third of COPD patients died during the weaning process. COPD patients had the worst outcome at 2-years, whereas over half of the NMD-CWD patients were alive at 2-years. These data strongly support the Department of Health's plan to develop 'Complex Home Ventilation, Weaning and Rehabilitation Centres' as part of the investment in specialist respiratory services to enhance patient outcome.