Organization and role of a specialized weaning unit in the trajectory of a patient with persistent critical illness

Abstract

Weaning units are medical structures offering a new model of care for patients with prolonged weaning and/or persistent critical illness following a prolonged stay in the intensive care unit (ICU). The hallmark of persistent critical illness is the prolonged ventilator dependence and is generally associated with a "syndromic" constellation of physiological changes, such as malnutrition, neuromyopathy (locomotion, swallowing), delirium, skin lesions and a state of immunosuppression. Beyond the specific activity of weaning and removal of the tracheostomy tube, the missions of care in a weaning unit are complex and multidisciplinary, involving nutritional support, motor rehabilitation, management of comorbidities, relief of symptoms, psychological support, and organization of follow-up and care after discharge. This review addresses the concept of persistent critical illness after a ICU stay and the public health issues it represents, traces the history of the development of weaning centers in France as well as their main structural and operating elements, to finally develop the main axes of therapeutic management.