Weaning Units The U.S. Perspective

University of Connecticut Medical School, Farmington. Connecticut, U.S.A. 

Only a small percentage of patients require ventilation for at least six hours per day for 21 days (2 These patients are often older, have more comorbid illnesses, and, liequendy, have underlying obstmetive lung disease (3,4). Patients who have had a shorter duration of mechanical ventilatory support during surgery are more likely to be successfully weaned (5,6). 

It is estimated that 5% of all ventilated patients require PMV (7). In 1986, Make et al. reported there to be 147 patients in Massachusetts, U.S.A., who met the definition for PMV (8). In 1989, Gallup Organization estimated that in the United States 11,400 patients required PMV. Clearly, the cost to the health care system is substantial. In the Gallup survey, in 1989, the daily cost of care was 789/day, resulting in an annual cost of US S3.2 billion—a large sum for a small patient population. 

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 

Although the clinical success of LTCH has been confirmed (3,12-14), there are no studies that compare their cost-effectiveness for PMV patients with acute care. Such studies would clearly be difficult in this small heterogeneous patient population and some would argue that it would be unethical, given the obviously large cost differences. 

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