Résumé :
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Background : Weaning failure occurs in up to 10% of patients weaning from mechanical ventilation. Such patients are transferred to our centre as a step-down facility to ascertain if successful weaning can be achieved. Previously presented data detailed the outcome of the patients referred (Thorax 2005; 60 : 187-192). However these, and other similar published data, have not reported on the patients that are referred but not transferred. Method : We prospectively collected data using a purpose designed database from January 2006 to January 2008 to coincide with the formal introduction of a consultant nurse outreach weaning service that provides on site assessment and advice and arranges transfer to our unit as necessary. Results : There were 163 referrals (102 M). 85% of these referrals were accepted for admission and 15% were declined admission. Only 67% of those accepted were admitted. We divided the patients who were not transferred into 4 groups : (1) weaning centre unnecessary (2) patient 'unweanable'; (3) weaned prior to transfer; and (4) died prior to transfer. Of 25 patients declined admission, 12 (48%) were identified as 'weanable' in their referring unit and 6 (50%) of these died. Furthermore, 12 (48%) were 'unweanable' with 8 (67%) of these patients transferred to an intermediate care facility and the remainder died. Of 46 patients accepted but not admitted, 25 (54%) were weaned whilst waiting for transfer by the nurse consultant and 21 (46%) died. The reason for a transfer delay was limited bed availability caused by a combination of discharge delay following successful weaning (11.3 ± 5.8 days) and discharge delay of tracheostomy ventilated patients out of our unit (93 ± 5.8; range 26-208). As a consequence mean delay in transfer to our unit was 18 ± 16 days (1-65days). Conclusion : This is the first report detailing the reason for non-admission of patients to a regional weaning centre. As expected, patients were declined admission when identified as requiring longterm tracheostomy ventilation in an intermediate care facility or were deemed to be 'weanable' in their referring centre. However, half of these 'weanable' patients died in the referral unit during the weaning process which highlights the difficulty in predicting weaning outcome from an initial assessment. More importantly, of those patients accepted but not transferred, almost 50% died prior to transfer. The reason for non-transfer was lack of level 3 bed availability.
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