8(th) International conference on management and rehabilitation of chronic respiratory failure: the long summaries – Part 3

Ambrosino, Nicolino; Casaburi, Richard; Chetta, Alfredo; Clini, Enrico; Donner, Claudio F.; Dreher, Michael; Goldstein, Roger; Jubran, Amal; Nici, Linda; Owen, Caroline A.; Rochester, Carolyn; Tobin, Martin J.; Vagheggini, Guido; Vitacca, Michele; ZuWallack, Richard

The primary outcome, weaning duration, defined from the first day of randomization to the day the patient was successfully weaned, was shorter with trach collar than with pressure support: 15 versus 19 days. Patients were considered weaning successes when they breathed without ventilator assistance for at least 5 days. A Cox proportional hazards model revealed that the rate of successful weaning was 1.43 times faster with trach collar than with pressure support. Mortality was equivalent in the two arms, but, of course, the study was not powered to detect a difference in mortality. Of the entire 500 randomized and non-randomized patients, 54 % were alive at 6 months after enrollment and 45 % were alive at 12 months. This survival rate is surprisingly high. To put the numbers in perspective, 1-year survival in older (66 years) patients ventilated in an ICU was approximately 40 % [64, 65] . That is, the LTACH patients in the study of Jubran et al., who were ventilated for 67 days, had a 1-year mortality comparable to ICU patients who were ventilated for 9 days. Indeed, 72 % of the 260 patients who had been weaned by discharge were alive at 12 months.