1

Weaning and Pulmonary Rehabilitation Unit, Auxilium

Vitae, Volterra (Italy)
2
Cardiothoracic Department,
Pulmonary Unit, University Hospital of Pisa (Italy),
3
Pulmonology Department, University of Sebelas Maret,
Surakarta, Indonesia.
Dewi Makhabah
1,3
, Yusup Soebagio
3
,Jatu Aphridasari
3
, Guido Vagheggini
1
,
Nicolino Ambrosino
1,2
.
2
RICU
Hospital location to treat
acute and acute on chronic
respiratory failure
Weaning
Center
facilities for
prolonged and
difficult weaning
from mechanical
ventilation
Background
3
Aim
analyze the
effectiveness of a
long term
weaning model
based on
sequential activity
of RICU and WC
Aim

retrospective analysis
60 months period
(February 2007-
December 2012) the
outcome and
characteristics of
tracheostomised
difficult to wean going
to RICU and if
necessary WC
Methods
Intensive Care Unit
RICU
ICU
Tuscany Region
Pulmonary
Unit
Tuscany Region
Weaning Center
Respiratory
Rehabilitation
Cardiology
Rehabilitation
Characteristic patients in
RICU
5
Total Weaned Unweaned p
n 119 70 49
m/f 71/48 41/29 30/19
Age (y) 71.09.9 69.910.1 72.79.6 0.075
PA02/FiO2 234.879.3 239.574.5 228.185.9 NS
pH 7.410.1 7.420.06 7.380.07 0.003
PaCO2 (mmHg) 44.312.1 40.69.1 49.414.0 <0.001
LOS RICU 23,2036,16 28,2845,38 15,9312,71 0.004
LOS ICU 29,2521,90 28,9522,75 29,6420,9 NS
6
0 10 20 30 40 50
Post Surgery
COPD
Cardiac disease
Trauma
Pneumonia
Other
GCA
Other respiratory
Unweaned
Weaned
Total Patients
Number of patients
0 10 20 30 40 50
Post Surgery
COPD
Cardiac disease
Trauma
Pneumonia
Other
GCA
Other respiratory
Unweane
d
Weaned
Total
Patients
Number of patients
ACG
7
RICU
119 pts
RICU
119 patients
weaned
70 patients
unweaned
49 patients
Acute care
hospital
4 pts




Dead
14
patients



Weaning
Center
31
patients

HMV<12h
3 patients
Weaned
18 patients
ICU
1 patients
Dead
9 patients



Acute care
hospital
10
patients




Neuro rehab
6
patients


Home
10
patients



Pulm rehab
44
patients

58,8%
58,1%
Total weaned: 70.1%
Mortality : 19.3%
Expected mortality based on
APACHE II : 25.6%
42,2%
Weaned patient in RICU : 58,8%
58,1% of unweaned RICU patient
successfully being weaned in weaning
center (WC)
Total weaning in both sequential
model are 70,1%.
The mortality of total patients is
19,3%, lower than expected mortality
based on APACHE II: 25,6%



The sequential activity of a RICU and a WC
resulted in additional weaning success rate of
difficult-to-wean patients.
The mortality rates are less than expected in
RICU and WC based on APACHE II



9