Page 69 - HA Convention 2016 [Abstracts (Day 1)]

Service Enhancement Presentations HOSPITAL AUTHORITY CONVENTION 2016

F4.3 Clinical Safety and Quality Service II 16:15 Room 421

Ventilator Weaning Team — the Winning Team
Cheng SL, Ng SW, Poon CL, Suen KM, Chan E, Chan V, Chu CM
Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong

Introduction

General medical wards in Hong Kong are often required to take care for patients receiving invasive mechanical ventilation
(IMV) who are rejected by the Intensive Care Unit (ICU). This drains resources significantly. Weaning is often not possible
without dedicated and trained personnel which causes a vicious circle. The Department of Medicine and Geriatrics of United
Christian Hospital received new government funding to operate two invasive ventilator beds in the respiratory ward. Patients
receiving IMV rejected by ICU would be assessed for a trial of weaning in this area.

Objectives
We report an audit of the outcomes of a cohort of patients managed by our IMV weaning team in the funded area.

Methodology Tuesday, 3 May

This is a prospective observational study. Cases receiving IMV but rejected by ICU, then admitted to IMV beds between
1 July, 2014 to 30 June 2015 were prospectively followed. Demographics and baseline physiological parameters were
described. Outcomes analysed include weaning success, discharge and death.

Results

During the one-year period, 43 IMV patients (male: female = 65%: 35%) were managed by the IMV team in the funded area.
The mean age was 73.4 ± 12.1 years and APACHE II score 30.8 ± 11.2. The primary conditions leading to IMV were imminent
or post-cardiorespiratory arrest (33%), pneumonia (28%), COPD (9%), cerebrovascular accidents (7%), severe asthma (5%),
neuromuscular disease (5%), obesity hypoventilation syndrome (2%), acute myocardial infarction (2%) and miscellaneous
causes (9%). After initial assessment, 14 patients (33%) were designated comfort care while IMV weaning was attempted
in 29 patients (67%). For those designated comfort care, all died within (IQR) 0 to 4 days. For those designated attempted
weaning, 25 (86%) were successfully weaned from IMV; the median time to weaning was 8 days and the 30-day weaning
success was 83%. Discharge from hospital was possible in 18 patients (62%) during the study period and the median time
to discharge was 94 days. On discharge, 61% returned home, 28% returned to elderly home and 11% was transferred to
infirmary beds. A minority of patients required long term oxygen (22%); tracheostomy (11%) and home non-invasive ventilation
(17%). Katz’s ADL score on discharge was (IQR) 0 to 4. The median survival was 106 days. When ICU resource is limited, IMV
beds managed by respiratory specialists facilitate weaning from IMV. The IMV beds has positive impacts on patients’ and
families’ experience, improves terminal care of end-stage patients and deliver favourable weaning results in selected patients.
It helps to reduce the accumulation of IMV cases in general medical wards.

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