Admission pattern and outcome in a UK weaning centre

Introduction

Although patients with weaning failure may be transferred to weaning centres, there are limited data on admission practice and clinical outcome.

Methods

We collected data prospectively from March 2005 to October 2009.

Results

There were 286 referrals of which 20% were not accepted for transfer. Patients that were not accepted were categorised as weanable locally, unweanable, or died prior to transfer. A total 172/229 accepted patients were admitted (mean age was 60 ± 17 years; 118 male). Forty-six per cent of these achieved ventilator independence with 21% requiring ongoing non-invasive ventilation (NIV). The median time to wean was 17 days with 16% of patients remaining tracheostomy ventilator dependent. The unit mortality was 17%. Neuromuscular disease (NMD) was the main referral group (36%) with a low mortality rate (6%). COPD and postsurgical patients both comprised 21% of the referrals and had respective mortalities of 37% and 25%. There were no in-hospital deaths in the obesity-related respiratory failure (ORRF) group, but this was the smallest referral group (3%). Of 57 patients declined transfer, 43 (83%) were assessed as unweanable and nine (17%) were assessed as weanable locally. Of 56 patients accepted but not transferred, 28 (50%) were weaned awaiting transfer and 23 (41%) died prior to transfer. Mean transfer delay was 20.3 ± 19.2 days and a major contributor to this delay was prolonged discharge delay following weaning (12.9 ± 19.3 days) and extended discharge delay of tracheostomy-ventilated patients (77.4 ± 51.8 days).

Conclusions

In conclusion, compared with our previous data [1], there was an absolute reduction in mortality of 10% with similar admission diagnoses, proportions achieving ventilator independence and requiring NIV, suggesting that this was not necessarily selection bias. NMD was the main referral group with a low mortality rate. Although COPD patients had the highest mortality, almost 50% were weaned from invasive ventilation. There were no in-hospital deaths in the ORRF group, but these patients had the longest weaning time. In addition, poor outcome was observed in patients accepted but not transferred due to delay. This study highlights the need for more speciality weaning facilities in the UK.