Weaning Outcome

Lower respiratory tract infection (pneumonia, tracheobronchitis) 31 

Sepsis with shock, GI hemorrhage, thromboembolism, ileus, other infections 10 

Author (reference) patients (days) Population survival (%) discharge (%) 

Dasgupta (119) 212 NR 33% ARDS (nonsurgical), 18% ARDS (surgical), 28% postop, 12% COPD, 4% NMD, 5% other medical 82 60 

Gracey (120) 549 NR NR (includes 206 patients from previous report) 93 60 

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Scheinhorn et al. recently reported on the weaning outcomes of ventilator-dependent survivors of catastrophic illness transferred to the post-ICU setting (11). The mean cost of care was approximately 63,000 and the average length of stay was 40 days. The LTCHs are less expensive in part because of the reduced overhead compared with an acute care... 

Weaning can be assisted with stable support techniques, which include multiple daily T-piece trials alternating with periods of ventilatory support, and techniques of progressively reducing ventilatory support such as synchronized intermittent mandatory ventilation (SIMV) and PSV. Prospective randomized trials of daily T-piece trials, PSV, or SIMV among intubated patients (39) favor T-piece and PSV approaches over SIMV. There is no evidence that more recent modes of ventilation further improve weaning outcomes (40). 

The age of the rat when CLA supplementation is commenced can influence outcome. When rats were fed CLA from weaning at 21 days of age until day 51 only, then administered a carcinogen at day 57, they were protected from subsequent tumor development. However, when CLA entered the diet for the same period of time after carcinogen administration and when the animals were older, there was no protection against tumor development. A continuous intake of CLA was then necessary to obtain equivalent protection. The period from 21 to 51 days of age corresponds to development of the mammary gland to adult stage morphology. 

Similarly, a multidisciplinary performance improvement team that included a pharmacist established a series of patient care protocols and tested the impact on the costs of care and outcome.Protocols were developed that eliminated many standing orders for laboratory tests, electrocardiograms, and chest x-ray films. Other protocols were directed toward the use of sedatives, analgesics, neuromuscular blocking agents, and ventilator weaning. The outcome and costs from a baseline evaluation of 72 patients were compared with 85 patients in the follow-up phase. Application of the guidelines reduced costs for laboratory tests by 65%, and the number of chest x-rays were reduced by 56%. The cost of neuromuscular block-... 

Vallverdu I, Calaf N, Subrrana M, et al. Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med 1998 158(6) 1855-1862. 

Ouellette DR, Emmons EE, Gallup RA. Elevated creatinine levels are associated with failure to wean and adverse outcomes in patients receiving mechanical ventilation. Am J Resp Crit Care Med 1999 159 A372. 

Krishnan JA, Moore D, Robeson C, et al. A prospective, controlled trial of a protocol-based strategy to discontinue mechanical ventilation. Am J Respir Crit Care Med 2004 169(6) 673-678. Scheinhom DJ, Chao DC, Steam-Hassenpflug M, et al. Outcomes in post-ICU mechanical ventilation a therapist-implemented weaning protoeol. Chest 2001 119(l) 236-242. 

Bagley PH, Cooney E. A community-based regional ventilator weaning unit development and outcomes. Chest 1997 111(4) 1024-1029. 

Pilcher DV, Bailey MJ, Treacher DF, et al. Outcomes, cost and long term survival of patients referred to a regional weaning centre. Thorax 2005 60(3) 187-192. 

Each year, over 400,000 patients in the United States receive mechanical ventilation as a result of acute or acute-on-chronic respiratory failure (1,2). About a quarter of acutely ventilated patients repeatedly fail attempts at weaning and may require prolonged mechanical ventilation (PMV) (Fig. 1) (3,4). The proportion of patients experiencing PMV ranges between 0% and 20% (5-13). Out of patients who survive PMV, 9-66% become dependent on long-term mechanical ventilation (LTMV) (4,9,14-21). Two factors account for these wide variations in the outcome. The first factor is differences in patient population. The second one is the nosology of what constitutes PMV and what constitutes LTMV is unsatisfactory. 

Scheinhom DJ, Chao DC, Steam-Hassenpflug M, et al. Outcomes in post-ICU mechanical ventilation a therapist-implemented weaning protocol. Chest 2001 119(l) 236-242. 

McLean SE, Jensen LA, Schroeder DG, et al. Improving adherence to a mechanical ventilation weaning protocol for critically ill adults outcomes after an implementation program. Am J Crit Care 2006 15 299-309. 

Henneman E, Dracup K, Ganz T, et al. Effect of a collaborative weaning plan on patient outcome in the critical care setting. Crit Care Med 2001 29 297-303. 

Tonnelier JM, Prat G, Le Gal G, et al. Impact of a nurses protocol-directed weaning procedure on outcomes in patients undergoing mechanical ventilation for longer than 48 hours a prospective cohort smdy with a matched historical control group. Crit Care 2005 9 R83-R89. 

Randolph AG, Wypij D, Venkataraman ST, et al. Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children. A randomized controlled trial, JAMA 2002 288 2561-2568. 

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