Weaning patients off mechanical ventilation in a chronic ventilation facility – using a standardised approach

BACKGROUND: We describe the standardised management of patients in a chronic ventilation facility (CVF) and the rate of weaning of chronically ventilated patients off mechanical ventilation. This population of patients is transferred from acute care facilities where they have been deemed “non-weanable” and require prolonged ventilation. METHODS: Admissions to our CVF were audited over a period of 3 years. We collected demographic and outcome data as well as the patients’ length of stay and disposition. Weaning in our centre proceeds step-wise with a reduction in the adaptive support ventilation (ASV) minute ventilation target. Once the target reaches 50% of minute ventilation, spontaneous breathing trials are introduced and progressively lengthened until the patient is weaned. RESULTS: In total, 125 patients were admitted during the 3 years. 109 were not weaned, and 16 were weaned, i.e. 12.8% of patients were safely weaned off mechanical ventilation. Of the patients not weaned, the mortality rate was 34.8%, and 38.5% were discharged alive to either home or another facility. CONCLUSIONS: Weaning chronically ventilated patients is possible without intensivists or respiratory therapists on staff when a standardised approach/manner is implemented. However, weaning success appears to be mainly related to patients’ co-morbidities.