Acute care hospitals weaning facilities

Table 6 Terminology of Weaning Facilities Outside Acute Care Hospitals Outside Acute Care Hospitals...

As noted above, an important trend in the management of LTMV patients has been the proliferation of so-called LTAC facilities that receive most of their patients from acute care hospitals, often with tracheotomies, many of whom are undergoing weaning. LTAC facilities accept patients recovering slowly from acute respiratory failure, especially from COPD exacerbations or the acute respiratory distress syndrome (ARDS), reflecting the increasing survival related to use of NIV (6) and low tidal volume ventilation (21),... 

Figure 1 The management of respiratory failure in the United States. Many patients are admitted initially to an acute care hospital. If they wean ptomptiy, they may spend time in an LTAC hospital for rehabilitation, and eventually return home. If they fail to wean, they undergo tracheostomy and are transferred to an LTAC when stable. Weaning attempts continue, and a mincnity of patients return home the rest remain at the LTAC or are transferred to a SNF. Patients who deteriorate while at LTACs or at home return to the acute care hospital fOT stabilization. Some patients with chronic respiratory failure do not require acute care but are ventilated noninvasively and remain home. Abbreviations COPD, chronic obstructive pulmonary disease NIV, noninvasive ventilation LTAC, long-term acute care SNF, skilled nursing facility.

The 1960s witnessed the continued support of some polio patients at home, as well as the introduction of mouthpiece ventilation for long term, even continuous, support at some specialized rehabilitation hospitals (4). The 1960s also ushered in intensive care units (ICUs) that served as specialized centers to treat patients with acute respiratory failure. Sophisticated mechanical ventilators were developed to treat these patients. Some of whom failed to wean and often spent weeks or months in these units because no other facilities were available to adequately care for them. 

---