Chronic Ventilator Service in a Chest Hospital- a new paradigm of standards

Abstract Description

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Authors (including presenting author) :

WONG KC1, LEE D1, SZETO CH1, YEE W1, TSANG YS1, SUN LF1, CHENG KM1, LEE YM1, TSE C2, TANG E2, LAW F3, WOO D4, MAN M5

Affiliation :

1Department of TB and Chest, 2Physiotherapy Department, 3Speech Therapy Department, 4 Medical Social Service Department, 5Dietetics Department, Wong Tai Sin Hospital

Introduction :

Funded under the government’s resource allocation exercise (RAE), WTSH has been designated to take over chronic ventilator-dependent (CVD) patients from acute medical wards of the Kowloon & NT clusters for further care since 2015; while our preceding ventilator service for the KWC in 2004-2014 was run without extra resources.

Objectives :

Centralizing care of CVD patients in specialized, respiratory centre serves the purposes of i) Enhancing service quality & patient outcomes, ii) Alleviating ventilator service burden of acute medical wards.

Methodology :

Adult patients requiring continuous, invasive mechanical ventilation for 60 days or more are eligible for admission to our centre. CVD patients assessed to have weaning/rehabilitative potentials are enrolled for multi-disciplinary rehabilitation for further weaning attempt and/or preparing for home mechanical ventilation. Health outcomes of the cohort (n=24) serviced under RAE fund in 2015-18 are compared with our historic controls (n=43) of 2004-2014.

Result & Outcome :

The 2015-18 RAE cohort (n=24) and the 2004-14 historic controls (n=43) are matched in gender (13M & 11F vs 21M & 22F, P=0.69) and mean number of ventilator days before transfer to our centre (467.1 vs 139.7, P=0.13); while there is a tendency for the RAE cohort to have a lower mean age (61.5 vs 70.0, P=0.049). The disease categories attributed for ventilator dependency are matched for “Neuromuscular diseases” 25% vs 16.3%, “COPD/Asthma” 20.8% vs 14.0%, and “Post cardiac arrest” 4.2 % vs 7.0% between the two groups, with corresponding P-values of 0.41, 0.49 & 0.71; while there is more “CNS disorders” in the RAE cohort, compared with the historic controls (45.8% vs 16.3%, P=0.01). There is significant increase in weaning success in the RAE cohort (n=24) of 2015-18, compared with the historic controls (n=43) of 2004-2014 (29.2% vs 7.0%; P=0.021). There are also significant reduction in the one year mortality (16.7% vs 69.8%; P=0.00003) and prevalence of long term mechanical ventilation cases (41.7% vs 83.7%; P=0.0006) in comparing between the two groups. With funding to effect a multi-disciplinary rehabilitative approach led by respiratory physician, service quality & health outcomes of CVD patients, including weaning success and survival can be improved.