Outcomes of prolonged intensive care and rehabilitation at a specialized multidisciplinary center in Sweden

Abstract

Background: Specialized clinics may improve the outcome for patients with prolonged intensive care stays. Admission may depend on diagnosis, need of respiratory support and more. We report the results from a Swedish specialized center with a multidisciplinary team approach to continued intensive care and simultaneous rehabilitation regardless of patients' primary diagnosis or ventilator need.Methods: All patients admitted and discharged from 2015 to 2018 were included.Demographics, diagnoses, ventilatory support requirement, discharge destination and survival were retrieved from the center´s quality registry.Results: A total of 181 patients, mean age 61 ± 16 years, 64% men, were analyzed. A neurological diagnosis was the cause for hospitalization in 46% of patients. Of the 55 patients admitted to the center for weaning from mechanical ventilation, 89% were successfully weaned within a median of 25 (interquartile range (IQR) 16-45) days. Decannulation was intended in 117 patients of which 90% were successful within a median of 25 (IQR 13-43) days. Readmission to intensive care was 4%. Most patients were discharged to their home or to rehabilitation clinics with a lower level of care. In-clinic mortality was 3%.Survival beyond 1 and 2 years after discharge was 79% and 70%, respectively. Conclusion:Patients with prolonged intensive care and complex medical needs treated at a specialized center in Sweden had weaning and decannulation rates comparable to or better than previously reported. Mortality was low, and most patients were discharged home or for further rehabilitation. This was achieved with a multidisciplinary team approach to continued intensive care and simultaneous rehabilitation.

High‐flow via a tracheostomy tube and speaking valve during weaning from mechanical ventilation and tracheostomy

“…Patient acceptance of treatment was high and in only three cases could the therapy not be applied as a OWV could not be used. Mortality was low in line with previous research data from the center, 20 and causes of deaths were not considered related to HFT‐T‐OWV treatment. The one incident of pneumothorax in a patient with repeated pneumothoraxes was deemed unlikely to be related to the HFT‐T‐OWV treatment, a conclusion supported by the benchtop experiments where maximum pressures were <2 cmH 2 O using the OPT 970 adapter.…”

Don’t stand there, but deliver tailored ICU rehabilitation services

“…12,13 Löfroth and colleagues report on the outcome of ICU survivors who were transferred from Karolinska university clinic to their Remeo ICU rehabilitation unit in Stockholm, Sweden. 14 They showed that transfer from an ICU environment to a specialised ICU rehabilitation centre is safe (in clinic mortality 3%) and results in successful weaning from the ventilator in most patients, a very high decannulation rate of tracheostomised patients, and a negligible ICU readmission rate. These results are remarkable if one considers that 46% of the described patients had a neurological diagnosis at original admission.…”