Background RCU in Leeds admits patients who had tracheostomy in ICU as part of acute admission and are slow to wean from ventilation. We looked at the long-term outcomes of attempted weaning from ventilator support in terms of survival and level of support at discharge. We also looked at length of stay (LOS), underlying diagnosis and comorbidities.

Methods Thirty one patients admitted to RCU as a step-down from ICU between October 2011 and July 2014 were included. Patients were identified using database and data was collected from electronic records and inpatient notes. Patients were excluded if they had tracheostomy inserted on a previous admission.

Results The demographics, length of stay on RCU and primary diagnosis leading to respiratory failure and intubation are described in Table 1. All except one patient had significant other comorbidities including muscular dystrophies, MND, COPD, IHD, etc. The average number of days spent in ICU after tracheostomy prior to step-down was 19+/-15. Eight (26%) patients died in hospital. Seventeen patients (55%) were discharged without any ventilatory support after decanulation, 3 required overnight NIV and 3 were discharged with tracheostomy ventilation. At 12 months post-discharge 16 (52%) patients were dead; 11 (35%) were not on any ventilatory support; 3 were continuing to be ventilated via tracheostomy, 1 remained on NIV.

Discussion and conclusion Patients coming for weaning from trachy-ventilation represent a complex group with diverse aetiology and have multiple comorbidities. Their stay in a high dependency area is unpredictable and the LOS varies considerably. While a third of patients remained successfully weaned at one year they carry a high in-hospital and 1 year mortality. LOS is influenced by the complexity of discharge planning often including patients from outside our catchment area. Our RCU like many others are not staffed to look after more than 2 trachy-ventilated patients at any one time which combined with prolonged stay slows down patient flow form ICU. This highlights the need for dedicated units for weaning with a team that is able to look after complex needs in hospital and coordinate complex discharges.