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Ventilator study is first to compare weaning methods

A study that compared two ways to wean patients from ventilators—machines that breathe for patients unable to breathe on their own—suggests the two methods are equally safe but that one requires less time and is thus less costly.

Patients who need prolonged ventilator care are usually transferred from intensive care units to long-term acute-care hospitals that specialize in weaning procedures. Care at these hospitals is especially costly—topping $1.3 billion nationwide, according to a 2008 survey. So cutting bed time by a few days can mean big savings.

The study was the first rigorous, large-scale comparison of ventilator weaning methods. It involved VA and university investigators from several sites and took place at the RML Long Term Acute Care Hospital in Chicago. Lead author was Amul Jubran, MD, of the Hines (Ill.) VA Hospital.

An initial group of 500 patients underwent a screening procedure: Those able to breathe on their own successfully after being taken off the ventilator—about a third of the patients—were excluded from the study. Those who needed special weaning support—316 patients in all—were randomized to one of two methods.

One group remained on ventilators but the pressure of the air being supplied to their lungs was carefully decreased over several days, until they could be safely disconnected from the machines. The other group was intermittently disconnected from the machines and allowed to breathe through an oxygen-delivery device hooked up to a tracheostomy collar. A tracheostomy is the surgery that creates a hole in the neck into the trachea, or windpipe.

Median weaning times were faster with the tracheostomy collar than with the decreasing-pressure method—15 days vs. 19 days. Survival at 6 and 12 months was the same among both groups.

Experts say the results offer valuable guidance for hospitals that specialize in caring for patients on ventilators.

(Journal of the American Medical Association, online Jan. 22, 2013)

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