What happens to patients in a nursing home-based, chronic ventilator unit: A five-year retrospective review of patients and outcomes

*Context: Assisted mechanical ventilation for prolonged periods has created a new class of ventilator-dependent patients. As a result, many nursing homes have created ventilator units to provide care for these patients. Information about this patient population is sparse. *Design: A five-year retrospective chart review of 95 patients admitted to a chronic ventilator unit from January 1, 1992, to February 1, 1997. There were no predetermined requirements for patient progress or weaning potential, except that patients be stable enough not to require intensive care unit monitoring, nursing, or technology. *Setting: A chronic ventilator unit located in a 168-bed nursing home. *Results: There was a slight female preponderance (56%) and an average age of 64 years. At admission, 25% of the patients had diminished consciousness, and only one third could be evaluated by the Folstein Mini-Mental State Examination. One third of the patients had an admitting diagnosis of pulmonary disease, most often chronic obstructive pulmonary disease. Twenty-six patients (17 females and 9 males) survived 12 or more months on the unit. The difference in survival between males and females was significant, (*2 > 0.02). Absolute survival, including survival of 15 patients freed from the ventilator and discharged, was also significantly different between men and women (*2 > 0.01). There were no substantial differences between those who survived more than one year and the total group of 95 patients. Of the 95 patients, 15 were successfully liberated from mechanical ventilation, 13 elected to discontinue mechanical ventilation, and 13 were still alive on mechanical ventilation in the nursing home. *Conclusions: Ventilatory care in a nursing home resulted in survival of more than one year in 19% of patients. Weaning and liberation from mechanical ventilation occurred in 15% of patients. When establishing a nursing home ventilator unit, provisions need to be made for both long-term survivors and a weaning program.