IngentaConnect Weaning units: lessons from North America?

Authors: Subbe, C. P.¹; Criner, G. J.²; Baudouin, S. V.³

Source: Anaesthesia, Volume 62, Number 4, April 2007 , pp. 374-380(7)

Abstract:

Summary

In the United Kingdom over 5% of critical care beds are occupied by stable patients weaning from mechanical ventilation. In North America, diagnosis related groups (DRGs) were introduced over a decade ago. These provided an economic impetus to develop more cost effective regional weaning centres. The imminent introduction of Payment By Results may encourage similar developments in the UK. The evidence for weaning centres is reviewed and detailed organisational and outcome data from two North American centres presented. These units differ from UK critical care units in terms of nurse : patient ratios and types and numbers of ancillary staff. Limited data, mostly from North America, suggest that weaning centres may be better at improving outcome in ventilator-dependent patients compared with standard critical care. The existing evidence is not conclusive and highlights the need for UK-based studies on organisational approaches to the provision of weaning and longer term critical care.

Document Type: Special article

DOI: 10.1111/j.1365-2044.2007.04984.x

Affiliations: 1: Specialist Registrar, Thoracic & General Medicine, Advanced Trainee Intensive Care Medicine, Wrexham Maelor Hospital, Wrexham LL13 4TD, UK 2: Director, Division of Pulmonology, and Critical Care Medicine Director, Medical Intensive Care Unit and Ventilator Rehabilitation Unit, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, USA 3: Senior Lecturer in Anaesthesia and Critical Care Medicine, Department of Anaesthesia, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK

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