Weaning from long-term mechanical ventilation: results in patients in a weaning unit

Background and objective: Patients subjected to an increased load and with a decreased capacity of their respiratory muscles may be difficult to wean from mechanical ventilation. Using a weaning strategy with a focus on unloa ding respiratory muscles may be successful even after long-term mechanical ventilation. In a prospective uncontrolled study, we examined the outcome o f our weaning protocol. Patients and methods: Under prolonged mechanical ventilation in outlying in tensive care units (44.3 +/- 38.1 days) 232 patients (64.8 +/- 12.7 years, 149 males, 83 females) with the following underlying diagnoses were investi gated: chronic obstructive pulmonary disease (54.3%), neuromuscular disease s (16%), thoracic restriction (10.8%), chronic left heart failure (7.3%), p ostsurgical ventilatory failure (6.9%) and miscellaneous conditions (4.7%). Our weaning strategy was focused on type of mechanical ventilation, endotr acheal tubes, non-invasive interface, oxygen supply and transport capacity, body position and home mechanical ventilation, if an increased load or a d ecreased capacity of the respiratory muscles remained after weaning. Results: Altogether 65% of the patients (n = 152) were weaned in a mean dur ation of 7.5 days. Intermittent home mechanical ventilation followed in 45 patients (19.4%). In our hospital died 64 patients (27.6%). After a stay of 19.7 +/- 12.2 days in our hospital 72.4% of the patients (n = 168) were di scharged. The postdischarge 3-month mortality of the cohort was 36.5%. Conc lusion: Applying our weaning strategy about 65% of the patients requiring l ong-term mechanical ventilation were successfully weaned. Weaning was achie ved in approximately one fifth of the time previously spent on mechanical v entilation. However, the 3-month mortality of the investigated cohort was 3 6.3%.