The Difficult-to-wean Patient

Nicolino Ambrosino; Luciano Gabbrielli


Expert Rev Resp Med. 2010;4(5):685-692. 

In This Article

Where to Treat the Difficult-to-wean Patient

It has been claimed that ICUs are expensive resources[2] and probably lack the necessary focus, personnel and organization to care for difficult-to-wean patients.[13,14] Therefore, alternative solutions have been investigated. Two types of units have been proposed as solutions to the problem of the inappropriate use of ICUs:[27]

  • Respiratory intermediate care units (RICUs) within acute care hospitals manage patients with ARF or ACRF with noninvasive ventilation, resulting in a significant reduction in ICU admissions and need for invasive MV,[3,4] with an adequate level of assistance, which is less costly than in a ICU. These units may also provide multidisciplinary rehabilitation[28] and serve as a bridge to home care programs or long-term care facilities.[29] Some of these RICUs may work also as 'step-down' units for difficult-to-wean patients;[30,31]

  • Specialized regional weaning centers (WCs), often located within rehabilitation hospitals, treat difficult-to-wean patients transferred from several acute care hospitals. Dedicated WCs offer specialized teams (e.g., nurses, respiratory therapists, nutritionists, psychologists and speech therapists) and also relieve pressure on scarce ICU beds at a lower costs. Variable mortality and weaning success rate have been reported.[9–11,31–33]


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