TY - JOUR
T1 - Weaning success among ventilator-dependent patients in a rehabilitation facility
AU - Modawal, Arvind
AU - Candadai, Niranjana P.
AU - Mandell, Karen M.
AU - Moore, Eileen S.
AU - Hornung, Richard W.
AU - Ho, Mona L.
AU - Tsevat, Joel
N1 - Funding Information:
Supported in part by DrakeCenter Inc.
PY - 2002
Y1 - 2002
N2 - Objectives: To determine outcomes of difficult-to-wean, ventilator-dependent patients transferred from intensive care units to rehabilitation hospitals and to determine predictors of weaning success in such patients. Design: A retrospective cohort study. Setting: A rehabilitation facility. Participants: One hundred forty-five difficult-to-wean patients (55.2% men; 83.4% white; mean age ± standard deviation, 65.8 ± 16.4y) transferred to a rehabilitation facility between July 1994 and June 1996. Interventions: Not applicable. Main Outcome Measures: Demographic and clinical data, including variables identified previously as predictive of weaning success among highly selected populations. Results: Patients' Gillespie categories (reason for ventilator dependency) included "other medical conditions" (eg, pneumonia, neurologic) in 42.1% of the cases, postoperative in 24.8%, previous lung disease (eg, chronic obstructive pulmonary disease, interstitial lung disease) in 15.2%, trauma in 11.7%, respiratory failure with multisystem failure in 3.4%, and uncomplicated acute lung injury (acute respiratory distress syndrome) in 2.8%. Of 145 patients, 50.3% were completely weaned, 4.8% were partially weaned, and 44.8% remained ventilator dependent. In a stepwise multivariable logistic regression analysis, significant predictors of weaning success included white race (odds ratio [OR] = 3.4), serum albumin level (OR = 2.1g/dL), and blood urea nitrogen (BUN) level (OR =.97mg/dL); in addition, compared with postoperative patients, patients with "other medical conditions" (OR =.15) or previous lung disease (OR =.08) were less likely to be weaned (area under receiver operating characteristic curve =.76). Among 31 long-term survivors who were interviewed at least 6 months after discharge from the rehabilitation facility, 58.1% rated their health-related quality of life as good or better. Conclusions: Half of the patients admitted to a rehabilitation facility were weaned from their ventilators. Predictors of weaning success included race, BUN level, albumin level, and reason for ventilator dependency.
AB - Objectives: To determine outcomes of difficult-to-wean, ventilator-dependent patients transferred from intensive care units to rehabilitation hospitals and to determine predictors of weaning success in such patients. Design: A retrospective cohort study. Setting: A rehabilitation facility. Participants: One hundred forty-five difficult-to-wean patients (55.2% men; 83.4% white; mean age ± standard deviation, 65.8 ± 16.4y) transferred to a rehabilitation facility between July 1994 and June 1996. Interventions: Not applicable. Main Outcome Measures: Demographic and clinical data, including variables identified previously as predictive of weaning success among highly selected populations. Results: Patients' Gillespie categories (reason for ventilator dependency) included "other medical conditions" (eg, pneumonia, neurologic) in 42.1% of the cases, postoperative in 24.8%, previous lung disease (eg, chronic obstructive pulmonary disease, interstitial lung disease) in 15.2%, trauma in 11.7%, respiratory failure with multisystem failure in 3.4%, and uncomplicated acute lung injury (acute respiratory distress syndrome) in 2.8%. Of 145 patients, 50.3% were completely weaned, 4.8% were partially weaned, and 44.8% remained ventilator dependent. In a stepwise multivariable logistic regression analysis, significant predictors of weaning success included white race (odds ratio [OR] = 3.4), serum albumin level (OR = 2.1g/dL), and blood urea nitrogen (BUN) level (OR =.97mg/dL); in addition, compared with postoperative patients, patients with "other medical conditions" (OR =.15) or previous lung disease (OR =.08) were less likely to be weaned (area under receiver operating characteristic curve =.76). Among 31 long-term survivors who were interviewed at least 6 months after discharge from the rehabilitation facility, 58.1% rated their health-related quality of life as good or better. Conclusions: Half of the patients admitted to a rehabilitation facility were weaned from their ventilators. Predictors of weaning success included race, BUN level, albumin level, and reason for ventilator dependency.
KW - Intensive care units
KW - Rehabilitation
KW - Respiratory failure
KW - Treatment outcome
KW - Ventilator weaning
KW - Ventilators
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U2 - 10.1053/apmr.2002.29614
DO - 10.1053/apmr.2002.29614
M3 - Article
C2 - 11833016
AN - SCOPUS:0036159072
SN - 0003-9993
VL - 83
SP - 154
EP - 157
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 2
ER -