Prospective observational cohort study of patients with weaning failure admitted to a specialist weaning, rehabilitation and home mechanical ventilation centre

摘要

Objectives According to National Health Service England (NHSE) specialist respiratory commissioning specification for complex home ventilation, patients with weaning failure should be referred to a specialist centre. However, there are limited data reporting the clinical outcomes from such centres. Setting Prospective observational cohort study of patients admitted to a UK specialist weaning, rehabilitation and home mechanical ventilation centre between February 2005 and July 2013. Participants 262 patients admitted with a median age of 64.2 years (IQR 52.6–73.2 years). 59.9 were male. Results 39.7 of patients had neuromuscular and/or chest wall disease, 21 were postsurgical, 19.5 had chronic obstructive pulmonary disease (COPD), 5.3 had obesity-related respiratory failure and 14.5 had other diagnoses. 64.1 of patients were successfully weaned, with 38.2 weaned fully from ventilation, 24 weaned to nocturnal non-invasive ventilation (NIV), 1.9 weaned to nocturnal NIV with intermittent NIV during the daytime. 21.4 of patients were discharged on long-term tracheostomy ventilation. The obesity-related respiratory failure group were most likely to wean (relative risk (RR) for weaning success=1.48, 95 CI 1.35 to 1.77; p0.001), but otherwise weaning success rates did not significantly vary by diagnostic group. The median time-to-wean was 19 days (IQR 9–33) and the median duration of stay was 31 days (IQR 16–50), with no difference observed between the groups. Weaning centre mortality was 14.5, highest in the COPD group (RR=2.15, 95 CI 1.19 to 3.91, p=0.012) and lowest in the neuromuscular and/or chest wall disease group (RR=0.34, 95 CI 0.16 to 0.75, p=0.007). Of all patients discharged alive, survival was 71.7 at 6 months and 61.8 at 12 months postdischarge. Conclusions Following NHSE guidance, patients with weaning delay and failure should be considered for transfer to a specialist centre where available, which can demonstrate favourable short-term and long-term clinical outcomes.