Authors (including presenting author) :
WONG KC1, YEE W1, TSANG YS1, SUN LF1, CHENG KM1, LEE YM1, TSE C2, LAW F3, MAN M4
Affiliation :
1Department of TB and Chest, 2Physiotherapy Department, 3Speech Therapy Department, 4 Dietetics Department, Wong Tai Sin Hospital
Introduction :
Funded by government’s resource allocation exercise (RAE) since 2015, we have adopted a new approach of multi-disciplinary rehabilitation and slow & gradual weaning in patients who are chronic ventilator-dependent (CVD). There is no extra resource to our preceding ventilator service in 2004 -2014 to deliver this special approach.
Objectives :
We attempt to improve service quality & weaning success in CVD patients by adopting a mixed approach of multi-disciplinary rehabilitation and slow & gradual weaning.
Methodology :
CVD patients are defined as adult patients requiring continuous, invasive mechanical ventilation for 60 days or more. Exercise training of upper limbs & shoulder girdle are emphasized, in addition to inspiratory muscle training in selected cases. Nutritional support and speech intervention to prevent recurrent micro-aspiration are also important elements of the rehabilitation. Ventilator support is gradually withdrawn in a slow pace with routine monitoring of vital signs, pulse oximetry and the rapid shallow breathing index, and ETCO2 & ABGs as appropriate. Spontaneous breathing trial (SBT) does not begin until low level of PS ventilation can be achieved. In contrast to weaning of acute mechanical ventilator patients, SBT extends beyond 2 hours and is gradually prolonged in a slow pace till complete ventilator liberation. Weaning success 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). Weaning success in CVD patients can be markedly enhanced by a mixed approach of rehabilitation and slow & gradual weaning led by respiratory physician.
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