A Community-Based Regional Ventilator Weaning Unit

Bagley, Peter H.; Cooney, Elaine

doi:10.1378/chest.111.4.1024

Cited by 78 publications

(49 citation statements)

References 11 publications

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“…Home discharge is easier if respiratory support is supplied through PNP instead of MV. 1 Our percentage of home discharge (69.1%) is similar to other published series of post-traumatic SCI patients (29-75%), 10,18 but greater than in the case of other unselected MV-dependent patients, between 20 19 and 55%. 20 Although in our study, we have not performed an economic evaluation, other authors 8 have demonstrated that the cost of stay in the case of chronically ventilated patients is remarkably reduced in units with lower level of care than the ICU.…”

Section: Discussionsupporting

confidence: 83%

See 1 more Smart Citation

An intermediate respiratory care unit for spinal cord-injured patients. A retrospective study

Romero-Ganuza¹,

García-Forcada²,

Vargas

et al. 2015

Spinal Cord

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Section: Discussionsupporting

confidence: 83%

“…Some experiences in SCI patients have shown promising results. [9][10][11][12] With this study, we have tried to evaluate the outcome of the IRCU of our hospital during 2.5 years, with the goal of establishing its efficacy in the treatment and follow-up of patients with respiratory failure due to SCI.…”

Section: Introductionmentioning

confidence: 99%

An intermediate respiratory care unit for spinal cord-injured patients. A retrospective study

Romero-Ganuza¹,

García-Forcada²,

Vargas

et al. 2015

Spinal Cord

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“…For example, one study showed that weaning success was highest in post-operative patients (58%) and those with acute lung injury (57%), and lowest in patients with COPD or neuromuscular disease (22%) [202]. The long-term survival rate after successful weaning is worse in patients with severe COPD compared with non-COPD patients [201].…”

Section: Specialised Weaning Unitsmentioning

confidence: 99%

“…Weaning strategies used in SWUs have included intermittent mandatory ventilation/PS, PSV, and T-tube trials [26,202,203,206,207]. VITACCA et al [26] studied 75 COPD patients randomised to PSV or T-tube SBT, both of which were delivered via the use of protocols.…”

Section: Specialised Weaning Unitsmentioning

confidence: 99%

Weaning from mechanical ventilation

Boles

Bion

Connors³

et al. 2007

Eur Respir J

1,660

1,499

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Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. Many controversial questions remain concerning the best methods for conducting this process. An International Consensus Conference was held in April 2005 to provide recommendations regarding the management of this process. An 11-member international jury answered five pre-defined questions. 1) What is known about the epidemiology of weaning problems? 2) What is the pathophysiology of weaning failure? 3) What is the usual process of initial weaning from the ventilator? 4) Is there a role for different ventilator modes in more difficult weaning? 5) How should patients with prolonged weaning failure be managed?The main recommendations were as follows. 1) Patients should be categorised into three groups based on the difficulty and duration of the weaning process. 2) Weaning should be considered as early as possible. 3) A spontaneous breathing trial is the major diagnostic test to determine whether patients can be successfully extubated. 4) The initial trial should last 30 min and consist of either T-tube breathing or low levels of pressure support. 5) Pressure support or assist–control ventilation modes should be favoured in patients failing an initial trial/trials. 6) Noninvasive ventilation techniques should be considered in selected patients to shorten the duration of intubation but should not be routinely used as a tool for extubation failure.

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“…Nonetheless, the profit may appear a least important objective for a hospital in which costs of beds in a critical care area are usually covered by the overall incomes covering the other health care activities. Indeed, previous reports from Europe [16] and US [3,[17][18][19] have shown significantly high costs and use of human resources in these critical care (although step-down) units. The problem of costs is very difficult to approach and many different items are crucial to quantify and therefore to subsequently assess the amount of reimbursement necessary.…”

Section: Discussionmentioning

confidence: 99%

Activity and analysis of costs in a dedicated weaning centre

Clini

Siddu²,

Trianni³

et al. 2016

Monaldi Arch Chest Dis

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Aim. To analyse the diagnosis-related characteristics and the costs of treating patients with difficult/prolonged weaning from mechanical ventilation we have undertaken a retrospective observational study. Methods. The study has considered all the patients admitted to our weaning unit of a regional Rehabilitation department during 3 consecutive periods since the opening date. Characteristics of the admitted patients and the DRG-related cares delivered have been recorded. A cost analysis has been obtained over time. Results. The number of beds allocated to this unit (from 4 in the 1st period to 6 in the 2nd and 3rd periods) and the number of patients cared for (from 32 to 43 and to 65, respectively) increased over time. In particular, the COPD to non-COPD patient ratio (from 2.2 to 1.3 and to 1.0) and the DRG/patient weight (from 3.0±0.3 to 3.1±0.2 and to 3.3±0.2 point) changed significantly (p<0.05). The daily reimbursement per patient from the public health care system only slightly increased, whereas the operating margin (reimbursement less costs) per patient significantly improved (from -304, to +17 and +55 €/pt/day, respectively, p<0.05) due to a gradual restriction in the variable costs. Length of stay, mortality rate and weaning rate did not change over time. Conclusion. The weaning centre is a hospital area where economic burdens should be carefully evaluated. Given the actual reimbursement received on a national level for these patients, variable costs might be better spread, thus optimising the burdens without losing out on clinical outcomes.

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A Community-Based Regional Ventilator Weaning Unit

Cited by 78 publications

References 11 publications

An intermediate respiratory care unit for spinal cord-injured patients. A retrospective study

An intermediate respiratory care unit for spinal cord-injured patients. A retrospective study

Weaning from mechanical ventilation

Activity and analysis of costs in a dedicated weaning centre

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