Weaning success among ventilator-dependent patients in a rehabilitation facility
| Autor: | Karen M. Mandell, Arvind Modawal, Mona L. Ho, Eileen S. Moore, Richard W. Hornung, Joel Tsevat, Niranjana P. Candadai |
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| Rok vydání: | 2002 |
| Předmět: |
Male
Patient Transfer Risk medicine.medical_specialty medicine.medical_treatment Physical Therapy Sports Therapy and Rehabilitation Lung injury Rehabilitation Centers law.invention law Internal medicine Intensive care Outcome Assessment Health Care medicine Weaning Humans Aged Ohio Retrospective Studies Analysis of Variance Rehabilitation business.industry Retrospective cohort study Odds ratio Intensive care unit Multivariate Analysis Physical therapy Female business Ventilator Weaning Cohort study |
| Zdroj: | Archives of physical medicine and rehabilitation. 83(2) |
| ISSN: | 0003-9993 |
| Popis: | Modawal A, Candadai NP, Mandell KM, Moore ES, Hornung RW, Ho ML, Tsevat J. Weaning success among ventilator-dependent patients in a rehabilitation facility. Arch Phys Med Rehabil 2002;83:154-7. Objectives: To determine outcomes of difficult-to-wean, ventilator-dependent patients transferred from intensive care units to rehabilitation hospitals and to determine predictors of weaning success in such patients. Design: A retrospective cohort study. Setting: A rehabilitation facility. Participants: One hundred forty-five difficult-to-wean patients (55.2% men; 83.4% white; mean age ± standard deviation, 65.8 ± 16.4y) transferred to a rehabilitation facility between July 1994 and June 1996. Interventions: Not applicable. Main Outcome Measures: Demographic and clinical data, including variables identified previously as predictive of weaning success among highly selected populations. Results: Patients' Gillespie categories (reason for ventilator dependency) included "other medical conditions" (eg, pneumonia, neurologic) in 42.1% of the cases, postoperative in 24.8%, previous lung disease (eg, chronic obstructive pulmonary disease, interstitial lung disease) in 15.2%, trauma in 11.7%, respiratory failure with multisystem failure in 3.4%, and uncomplicated acute lung injury (acute respiratory distress syndrome) in 2.8%. Of 145 patients, 50.3% were completely weaned, 4.8% were partially weaned, and 44.8% remained ventilator dependent. In a stepwise multivariable logistic regression analysis, significant predictors of weaning success included white race (odds ratio [OR] = 3.4), serum albumin level (OR = 2.1g/dL), and blood urea nitrogen (BUN) level (OR =.97mg/dL); in addition, compared with postoperative patients, patients with "other medical conditions" (OR =.15) or previous lung disease (OR =.08) were less likely to be weaned (area under receiver operating characteristic curve=.76). Among 31 long-term survivors who were interviewed at least 6 months after discharge from the rehabilitation facility, 58.1% rated their health-related quality of life as good or better. Conclusions: Half of the patients admitted to a rehabilitation facility were weaned from their ventilators. Predictors of weaning success included race, BUN level, albumin level, and reason for ventilator dependency. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation |
| Databáze: | OpenAIRE |
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