PT  - JOURNAL ARTICLE
AU  - Abdel Hakim Bayarassou
AU  - Wolfram Windisch
AU  - Jan Hendrik Storre
TI  - Secondary gain from illness leading to prolonged weaning failure
DP  - 2012 Sep 01
TA  - European Respiratory Journal
PG  - P2029
VI  - 40
IP  - Suppl 56
4099  - http://erj.ersjournals.com/content/40/Suppl_56/P2029.short
4100  - http://erj.ersjournals.com/content/40/Suppl_56/P2029.full
SO  - Eur Respir J2012 Sep 01; 40
AB  - Objective: For some patients prolonged weaning from invasive ventilation comes along with a temporary transfer to home mechanical ventilation. This is associated with a high logistic support, infrastructure of staff and costs for health insurance. Here, patients' physical abilities for weaning needed to be monitored closely to avoid mismanagement of patients.Methods: Tracheotomised COPD-patients on home mechanical ventilation were analysed during readmission for a follow-up visit and possible decannulation.Results: Three COPD-patients were identified. All patients showed clear evidence to perform weaning from invasive positive pressure ventilation. However, one homeless patient (50years/male) refused to be weaned due to anxiety loosing his new established home environment. A second patient (64years/male) refused to be weaned based on fear loosing the financial support given from the health insurance to patient's family for nursing. A third patient (65years/female) was successfully weaned to noninvasive ventilation, but called for re-tracheostomy due to fear loosing infrastructure of staff at home.Conclusion: Prolonged weaning and establishment of invasive home mechanical ventilation can lead to secondary gain from illness. Following, the goal of self-determined living can be contrary to prospective medical therapy.