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Inpatient and long-term outcomes of individuals admitted for weaning from mechanical ventilation at a specialised ventilation weaning unit.
MedLine Citation:
PMID:  22985330     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
SUMMARY AT A GLANCE: This study identifies factors associated with weaning success and mortality in a cohort of patients admitted to Australia's first specialised ventilation weaning unit. It reports a ward-based model of care that safely achieved a high rate of weaning success for patients who had previously failed to wean from mechanical ventilation in an ICU setting. ABSTRACT: Background and Objective:  Weaning from invasive mechanical ventilation (IMV) in specialised weaning units has been demonstrated to be safe and cost-effective. Success rates and outcomes vary widely, probably relating to patient factors and unit expertise. Methods:  An audit was undertaken of patients admitted for weaning from IMV at the Austin Hospital Ventilation Weaning Unit (VWU) between March 2002 and January 2008. Weaning success, complications and both in-hospital and long-term mortality were examined and regression analysis was undertaken to examine factors related to these outcomes. Results:  78 patients were admitted to the VWU after a median of 27 days of IMV at their referring centre. Weaning success rate (ventilator free or nocturnal non-invasive ventilation only) was 78.2% (n=61). Inpatient mortality was 10.2% (n=8) and serious complications were infrequent. Progressive neuromuscular disease (OR 0.10) and sepsis during admission to the VWU (OR 0.09) were predictive of weaning failure at discharge. Increasing age (HR 1.93) and referral from rural or outer metropolitan centres (HR 3.57 and 2.37 respectively) were associated with increased long-term mortality. A diagnosis of either stable (HR 0.19) or progressive neuromuscular disease (HR 0.27) was associated with lower long-term mortality when compared to patients with COPD (HR 1.00). Overall survival at 12 months following discharge from the VWU was 66.7% (n=52) with most survivors residing in the community. Conclusions:  High rates of weaning success with infrequent complications and low mortality were achieved in this specialised non-ICU-based weaning unit. The VWU may provide a useful template for the development of similar units elsewhere. © 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.
Authors:
Liam M Hannan; Siew Tan; Kim Hopkinson; Emma Marchingo; Linda Rautela; Karen Detering; David J Berlowitz; Christine F McDonald; Me Howard
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-18
Journal Detail:
Title:  Respirology (Carlton, Vic.)     Volume:  -     ISSN:  1440-1843     ISO Abbreviation:  Respirology     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9616368     Medline TA:  Respirology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.
Affiliation:
Department of Respiratory & Sleep Medicine, Austin Hospital, Heidelberg, Victoria 3084, Australia Department of Medicine, Austin Health and Northern Health. Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria 3010, Australia.
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