Evolving outcomes of tracheostomised patients requiring prolonged mechanical ventilation before and after implementation of a respiratory high-dependency unit in a tertiary care hospital.
B. Herer (Briis sous Forges, France), C. Karanfilovic (Briis sous Forges, France), H. Maas (Briis sous Forges, France), H. Jaillet (Briis sous Forges, France), C. Darné (Briis sous Forges, France), F. Haniez (Briis sous Forges, France)
Source: International Congress 2018 – Pulmonary rehabilitation: exercise training, body composition, physical activity and other aspects
Disease area: Respiratory critical care
Abstract The aim of this study was to describe the outcomes of tracheostomised patients requiring prolonged mechanical ventilation (PMV) before and after implementation in January 2015 of a respiratory high-dependency unit (RHDU) in a tertiary care hospital. All patients had previously been tracheostomised, mainly admitted for respiratory failure and/or weaning from mechanical ventilation. Two groups were computed. Group 1 includes 109 consecutive stays (median [interquartile range, IQR] = 42 [26-77]) from December 2010 to December 2012 in a 34-bed intermediate-care facility located inside a respiratory ward. Patients were transferred from ICU (40.4%), home (40.4%) or respiratory ward of an other hospital (19.2%) (n=66, 70±10 years, 59% men). Group 2 includes 146 consecutive stays (median, IQR = 27 [10-41]) from January 2016 to June 2017 in a 12-bed RHDU working as an independent entity. All patients were transferred from ICU (n=121, 69±10 years, 65% men). The characteristics of the groups are summarised in Table.
Group 1
Group 2
P
COPD as a cause of respiratory failure (%)
30.3
26.9
0.70
Age-adjusted Charlson score (mean ± standard deviation)
5.6 ± 2.0
5.9 ± 2.4
0.29
Weaning from PMV at discharge (part-time or full-time) (%)
30.3
69.0
<10-4
Decannulation at discharge (%)
13.8
59.4
<10-4
Discharged home (%)
71.6
16.0
<10-4
Transfer to respiratory ward (%)
10.0
60.0
<10-4
Transfer to ICU (%)
3.7
17.5
0.0013
Death during RHDU stay (%)
14.7
6.5
0.051
We conclude that the implementation of a RHDU modifies the outcomes of tracheostomised patients with PMV, notably higher rates of weaning and decannulation.
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B. Herer (Briis sous Forges, France), C. Karanfilovic (Briis sous Forges, France), H. Maas (Briis sous Forges, France), H. Jaillet (Briis sous Forges, France), C. Darné (Briis sous Forges, France), F. Haniez (Briis sous Forges, France). Evolving outcomes of tracheostomised patients requiring prolonged mechanical ventilation before and after implementation of a respiratory high-dependency unit in a tertiary care hospital.. 4130
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