Difficult and Prolonged Weaning: The Italian Experience

Abstract

In Italy, the implementation of Pulmonologist’s centres working as step-down units for the management of patients discharged from intensive care units (ICUs) as result of difficult or prolonged weaning from invasive mechanical ventilation (IMV) largely coincides with the birth and growth of Respiratory ICUs (RICUs). The mission of RICUs which function as weaning centers is to facilitate the discharge of critically ill patients from ICU, to increase the rate of success in totally or partially liberating ventilator-dependents patients from IMV, to activate the delicate transitional process at home of chronically critical patients. The second national census of the Italian RICUs depicted different models of units depending on the prevalent “rehabilitative” or “acute” vocation, location, human resources, organizational and structural model, integration with the territory. Unfortunately, according to the census, training of medical and nursing staff on RICU’s procedures is still insufficient. Finally, there is a need to set-up regional networks according to the logic of “hub-spokes” in order to optimize the limited health-care resources allocated for weaning units in Italy.