The need for a regional weaning centre, a one‐year survey of intensive care weaning delay in the Northern Region of England*

Abstract

SummaryOver a period of one year, a weekly telephone survey identified 161 stable patients with weaning delay (defined as patients ventilated for at least 6 h per day for more than 2 weeks) in intensive care units in the Northern Region of England. Their median age was 69 years (range 21-88 years). Sixty patients (37%) were admitted with medical conditions, 89 (55%) were postoperative patients, whereas 12 (8%) were surgical but required non-operative admission. One hundred and thirty (89%) were weaned and discharged from the intensive care unit during the year. Twenty-two (14%) died and two were transferred to the home ventilation service. Seven patients remained ventilated in intensive care at the end of the study period. Twenty patients (12%) required more than 28 days of respiratory support. These patients occupied on average 6.0% of available intensive care unit beds in the region. This study suggests that in the Northern Region of England there are a significant number of stable but ventilator-dependent patients occupying intensive care beds.

Conventional Weaning Parameters Do Not Predict Extubation Outcome in Intubated Subjects Requiring Prolonged Mechanical Ventilation

“…27 Development of a severity scoring system for PMV patients is important because these patients consume a disproportionate amount of healthcare resources and have high medical costs. 28,29 Such a scoring system could facilitate earlier and more definitive discussions between physicians and patients/surrogates regarding appropriate goals of care. Thus, defining adequately performing and validated severity measures is urgently needed.…”

Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility

“…8 Patients needing prolonged mechanical ventilation (PMV) 9 may require transfer to a protected environment such as a chronic ventilator facility, 3,10 which studies have shown can offer some clinical and financial advantages over a prolonged ICU stay. 3,11,12 In particular, patients may receive a prompt and dedicated physiotherapy rehabilitation program in chronic ventilator facilities, 1,3,13 and transfer from an ICU to a chronic ventilator facility substantially improved patients' ambulation and activities of daily life irrespective of the underlying pathophysiology, avoiding unnecessary immobilization 14 . To date, the role of comprehensive rehabilitation in critically ill adults still remains controversial 13 or not fully established 15 : patients who have survived a recent acute respiratory failure (ARF) event can benefit from an individually tailored physiotherapy rehabilitation program that improves clinical indices, respiratory and peripheral muscle strength, activities of daily life, exercise tolerance, and disability scores. 14,[16][17][18][19][20][21][22][23][24] Once the precipitating cause of the ARF episode has been solved, these chronically ill patients still require care due to their huge motor disabilities, clinical dependence (oxygen, mechanical ventilation, nutritional, and communication device needs), and nursing necessities, 3 which the care team (physiotherapist, doctor, and nurse) must measure to better guide the daily care of the patient.…”

Weaning from mechanical ventilation

“…This extrapolates to a saving of more than £5 million per year for the whole of England. 22 The ideal location of such units remains undecided, but both within-hospital and stand-alone solutions appear to be successful in other countries.…”