EXTENDED CARE FACILITY PATIENTS TRANSFERRED FROM INTENSIVE CARE TO LONG-TERM ACUTE CARE FOR WEANING FROM PROLONGED MECHANICAL VENTILATION

Abstract

PURPOSE: To characterize the population and report outcomes, disposition and post-discharge survival of extended care facility (ECF) residents transferred from intensive care units (ICU) to Barlow Respiratory Hospital (BRH), a long-term acute care hospital (LTACH), for weaning from prolonged mechanical ventilation (PMV). METHODS: The Ventilation Outcomes Database (VOD) was queried for patients with pre-morbid location of ECF. VOD data were collected by trained personnel from transfer records and BRH medical records; weaning outcome was scored at discharge. Social Security Death Index (SSDI) determined post-discharge survival. RESULTS: 472 patients admitted for weaning from PMV were discharged from BRH 4/1/07-9/30/08. 104/472 (22%) had pre-morbid location of ECF; 97% with poor pre-morbid functional status by Zubrod Score. Age: 75.0 [33-97] years. On admission to BRH: Glasgow Coma Score (GCS) 10.0 [3-15]; APACHE III Acute Physiology Score (APS) 47.0 [23.0-93.0]; stage II or greater pressure ulceration in 49%. Outcomes: 50.0% weaned, 39.4% remained ventilator-dependent, 10.6% died. Length of stay 32.0 [1-159] days; time to wean 16.0 [4-52] days. Disposition for the 93 survivors: 83% returned to ECF, 2% went home, 15% transferred to acute hospitals for intercurrent medical problems. Tracheostomy retained in 92% of weaned patients. Six-month mortality post-discharge was 53.8%. Weaning success for patients from home was 48.6%. CONCLUSION: Patients with pre-morbid location of an ECF, with accompanying poor pre-morbid functional status before their catastrophic illness, ICU experience, and PMV experienced weaning outcomes equal to those of patients living at home prior to PMV. The vast majority of survivors returned to ECFs, now with the added burdens of ventilator dependency and/or tracheostomies. CLINICAL IMPLICATIONS: The six-month post-discharge mortality is not unexpected in a population of ECF residents who survive catastrophic illness. Not surprising, these episodes of critical illness end with total dependence, requiring prolonged and complex continued medical care. These data may be useful in addressing quality of life issues, and improving communication and decision-making among elderly patients, their families, and physicians.