[Experience of an intermediate respiratory intensive therapy in the treatment of prolonged weaning from mechanical ventilation]

109 patients who suffered from an episode of acute respiratory failure, necessitated mechanical ventilation (MV) in a general Intensive Care Unit (ICU) and admitted to our Respiratory Intermediate Intensive Unit (RIIU), were retrospectively evaluated for outcome and weaning success. The patients, 69 +/- 9 years old, presented the following diseases: COLD (70\%), cardiovascular (15\%) and neuromuscular (15\%). A relapse of underlying disease (62\%), pneumonia (20\%), thoraco-muscular pump failure (15\%) and pulmonary embolism (3\%) were the relapsing causes needing the ICU admission. Patients remained intubated for 12 +/- 6 days and ventilated for 25 +/- 10 days. They were transferred to RIIU on pressure support ventilation (70\%); the causes of prolonged and/or difficult weaning were as following: lung failure (48\%), pump failure (12\%), cardiac and haemodynamic instability (28\%) others (12\%). Apache II score was 18 +/- 5. Maximal inspiratory pressure (31 +/- 7 cmH2O) and respiratory rate/tidal volume (83 +/- 34) were measured within 48 hours after RIIU admission. 82 subjects (75\%) were weaned after 6 +/- 4 days of MV using in 87\% of patients pressure support technique with spontaneous breathing cycles with oxygen supplementation. 8 patients on 109 (7\%) died; 20 patients on 109 (18\%) were discharged after 40 +/- 9 days of stay in RIIU necessitating home MV more than 18 hours/day by means of a tracheostomy. All patients stay in RIIU for 17 +/- 7 days with a mean cost per die of 750 thousands lire. Our data suggest that a RIIU institution for prolonged weaning in chronic diseases may be a useful solution to decrease superfluous stays in ICU decreasing costs without ba worsening in quality of care.