Weaning facilities

The precise definition of WF as well as the timing and admission to them varies among different jurisdictions. Various facilities that provide PMV are summarized in Table 2. 

Intensive care Weaning feisty Weaning faciity 

Complex weaning strategy Comprehensive team Day night rhythm Intimacy 

ICU Life threatened High-tech intensive Expensive 

Step-down unit One organ Cost-effective for Reduced level of care 

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Limited ++ high level. Abbreviation WF, weaning facilities. 

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

Pig trials were conducted at the Kingsville Swine Unit of Texas A M University in the USA. The unit is a farrow-to-finish operation and has been in production for approximately 25 years. This facility has experienced episodic problems with post-weaning scours, which on occasion has resulted in relatively high morbidity and mortality rates. 

In a retrospective study of 319 patients, multivariate analysis identified shock on ICU admission day as the only independent predictor for PMV (>21 days) (47). In a prehminaty study of 111 patients, increased duration of MV and need for transfer to a long-term ventilator care facility was associated with a creatinine elevation of 1.3 mg/dL anytime during the ICU stay (48). In another study, none of the 52 patients with PMV and renal failure were successfully weaned (49). Chao and colleagues reviewed >1000 patients transferred to their regional weaning center and identified 63 with renal dysfunction, with creatinine >2.5 mg/dL (40 on renal replacement therapy) (50). When compared to those with creatinine <2.5 mg/dL, patients with renal dysfunction were less likely to wean from MV (13% vs. 58%). 

Scheinhorn DJ, Chao DC, Hassenpflug MS, et al. Post-lCU weaning from mechanical ventilation the role of long-term facilities. Chest 2001 120(6 suppl) 482S 84S. 

Modawal A, Candadai NP, Mandell KM, et al. Weaning success among ventilator-dependent patients in a rehabilitation facility. Arch Phys Med Rehabil 2002 83(2) 154-157. 

Tulaimat A, Jubran A, Petrak RA, et al. Mortality in patients admitted to specialized facility for weaning from mechanical ventilation. Am J Respir Crit Care Med 2002 165 A31. 

Many of the rehabilitation strategies for critically ill patients are organized in facilities for long-term mechanical ventilation (LTMV) or within specialized respiratory ICUs. Patients are transferred to these facilities when their LOS in ICU exceeds a set criterion (often 21 days) or when the patient is perceived as difficult to wean. Several investigators have... 

Following implementation of the rehabilitation framework, May was weaned from MV and decannulated within 21 days. Her total LOS was 72 days at a cost of 108,000 (S204,588). She was transferred to the ward but waited for another 33 days before being transferred to a rehabilitation facility, where she stayed for 21 days. Now, one year later. May lives at home, cares for herself, socializes, and is making good progress. 

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. 

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.

When looking across each level of facility, the weaning rates and mortality rates were 41.2% and 14.9% in RCC, and 6.4% and 14.0% in RCW, respectively. The details of... 

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