Introduction The expansion of specialised weaning centres serving networks of external ICUs has been recommended by the NHS commissioning board. However, data are limited for this proposed model of care. Papworth Hospital provides a multi-disciplinary weaning service in-line with these recommendations.
Methods We analysed the records of patients transferred to our service for weaning from invasive ventilation (IMV) between 1992–2011 inclusive. Patients were categorised according to diagnosis (neuromuscular, COPD, post-surgical, non-COPD respiratory, chest-wall disorders and others).
Results 458 patients receiving IMV (92% via tracheostomy) were transferred (mean age 61 years, 259 (57%) male, 421 (92%) from external ICUs with a median ICU stay of 33 days. On arrival, 422 (92%) were ventilator-dependent and 37 (8%) required nocturnal IMV. The median PaCO2 was 10 kPa. Neuromuscular problems included Motor Neurone Disease (21%), Tetraplegia (12%), Muscular Dystrophies (11%), and Myotonic Dystrophy (9%).
417 (91%) patients survived to hospital discharge, with 330 (72%) weaned from IMV (median stay 24 days if decannulated, 37 days if IMV continued). Non-invasive ventilation (NIV) facilitated weaning in 79%. From the date of ICU admission, 63% of the whole cohort were alive at 1 year, 43% at 3 years, and 33% at 5 years. When adjusted for case-mix, survival was similar for external and in-house referrals. At least 343 (82%) survivors were discharged home. Further outcome data are summarised in Table 1.
COPD patients had the lowest rate of death and/or failed decannulation (13%); further, long-term NIV was associated with a significant increase in survival (p = 0.01), despite normocapnia (5.9kPa) if completely weaned. 33% neuromuscular patients required long-term IMV, typically due to bulbar problems, although 65% were discharged home. Continued IMV in other groups conferred a very poor prognosis.
Conclusions These data confirm high levels of survival and discharge home in patients referred to a specialised weaning service. Repatriation to the referring ICU was rarely necessary. NIV was important in the graded withdrawal of IMV and the provision of domiciliary care. In COPD, NIV use on discharge was associated with improved survival. Overall outcomes were favourable when compared to international data and are supportive of current national service plans.
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