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Ventilator-Dependent Survivors of Catastrophic Illness Transferred to 23 Long-term Care Hospitals for Weaning From Prolonged Mechanical Ventilation^*

David J. Scheinhorn, MD, FCCP; Meg Stearn Hassenpflug, MS, RD; John J. Votto, DO, FCCP; David C. Chao, MD, FCCP; Scott K. Epstein, MD, FCCP; Gordon S. Doig, PhD; E. Bert Knight, MD, FCCP; Richard A. Petrak, MD; for the Ventilation Outcomes Study Group

^* From Barlow Respiratory Hospital and Research Center (Dr. Scheinhorn and Ms. Hassenpflug), Los Angeles, CA; Hospital for Special Care (Dr. Votto), New Britain, CT; Oak Bend Medical Center (Dr. Chao), Richmond, TX; Tufts University School of Medicine (Dr. Epstein), Boston, MA; Institute for International Health (Dr. Doig), University of Sydney, Sydney, Australia; Spartanburg Hospital for Restorative Care (Dr. Knight), Spartanburg, SC; and RML Specialty Hospital (Dr. Petrak), Hinsdale, IL. A list of participants for the Ventilation Outcomes Study Group is given in the ^Appendix.

Correspondence to: Meg Stearn Hassenpflug, MS, RD, Barlow Respiratory Hospital and Research Center, 2000 Stadium Way, Los Angeles, CA 90026; e-mail: megstearn{at}aol.com

Abstract

Study objectives: This multicenter study was undertaken to characterize the population of ventilator-dependent patients admitted to long-term care hospitals (LTCHs) for weaning from mechanical ventilation.

Design: Observational study with concurrent data collection. Characteristics of the LTCHs were also surveyed.

Setting: Twenty-three LTCHs in the United States.

Patients: Consecutive ventilator-dependent patients admitted over a 1-year period: March 1, 2002, to February 28, 2003.

Results: A total of 1,419 patients were enrolled in the Ventilation Outcomes Study. Median age of the patients was 71.8 years old (range, 18 to 97.7 years), with an equal gender distribution. The premorbid domicile was home or assisted living in 86.5%; "good" premorbid functional status (Zubrod score 0–2) was assessed in 77%. There was a history of smoking in 59% (mean, 57 ± 42 pack-years [± SD]); premorbid diagnoses averaged 2.6 per patient. Patients came to the LTCH after mean of 33.8 ± 29 days at the transferring hospital; mean time to tracheotomy was 15.0 ± 10 days. A medical illness led to ventilator dependency in 60.8% of patients; a surgical procedure led to ventilatory dependency in 39.2%. On admission to the LTCH, the median acute physiology score of APACHE (acute physiology and chronic health evaluation) III was 35 (range, 4 to 115); > 90% of patients had at least three penetrating indwelling tubes/catheters; 42% of patients had stage 2 or higher pressure ulceration.

Conclusions: This is the first multicenter study to characterize ventilator-dependent survivors of catastrophic illness admitted to the post-ICU venue of LTCHs for weaning from prolonged mechanical ventilation (PMV). Overall, our findings suggest that ventilator-dependent patients admitted to LTCHs for weaning will continue to require considerable medical interventions and treatments, owing to the burden of acute-on-chronic diseases resulting in PMV.

Key Words: chronic critical illness • functional status • long-term care hospital • multicenter study • outcomes • post-ICU • prolonged mechanical ventilation • ventilator dependent • weaning

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