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Clinical factors associated with weaning failure in patients requiring prolonged mechanical ventilation
Hong-Joon Shin1, Jin-Sun Chang1, Seong Ahn1
1Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea.
Background:
For patients requiring prolonged mechanical ventilation (PMV), weaning is difficult and mortality is very high. PMV has been defined recently, by consensus, as constituting ≥21 consecutive days of mechanical ventilation (MV) for ≥6 hours per day. This study aimed to evaluate the clinical factors predicting weaning failure in patients undergoing PMV in medical intensive care unit (ICU).
Methods:
We retrospectively reviewed the clinical and laboratory characteristics of 127 patients who received MV for more than 21 days in the medical ICU at Chonnam National University Hospital in South Korea between January 2005 and December 2014. Patients who underwent surgery or experienced trauma were excluded from this study.
Results:
Among the 127 patients requiring PMV, 41 (32.3%) were successfully weaned from MV. The median age of the weaning failure group was higher than that of the weaning success group (74.0 vs. 70.0 years; P=0.003). The proportion of male patients was 58.5% in the weaning success group and 72.1% in the weaning failure group, respectively. The most common reasons for ICU admission were respiratory causes (66.1%) followed by cardiovascular causes (16.5%) in both groups. ICU mortality and in-hospital mortality rates were 55.1% and 55.9%, respectively. In the multivariate analysis, respiratory causes of ICU admission [odds ratio (OR), 3.98; 95% confidence interval (CI), 1.29-12.30; P=0.016] and a high sequential organ failure assessment (SOFA) score on day 21 of MV (OR, 1.47; 95% CI, 1.17-1.85; P=0.001) were significantly associated with weaning failure in patients requiring PMV. The area under the receiver operating characteristic (ROC) curve of the SOFA score on day 21 of MV for predicting weaning failure was 0.77 (95% CI, 0.67-0.87; P=0.000).
Conclusions:
Respiratory causes of ICU admission and a high SOFA score on day 21 of MV could be predictive of weaning failure in patients requiring PMV.
Insights
Weaning from prolonged mechanical ventilation (PMV) is challenging. Respiratory issues and high SOFA scores on day 21 predict weaning failure in ICU patients, aiding clinical decisions.
Area of Science:
- Critical Care Medicine
- Respiratory Medicine
- Intensive Care Unit Management
Background:
- Prolonged mechanical ventilation (PMV) is defined as ≥21 consecutive days of mechanical ventilation (MV) for ≥6 hours per day.
- Weaning from PMV is difficult, with high mortality rates.
- Identifying predictors of weaning failure is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate clinical factors predicting weaning failure in patients undergoing PMV in a medical intensive care unit (ICU).
- To identify specific indicators associated with successful or failed weaning from prolonged mechanical ventilation.
Main Methods:
- Retrospective review of 127 patients requiring MV for >21 days in a medical ICU.
- Exclusion of patients who underwent surgery or experienced trauma.
- Analysis of clinical and laboratory characteristics, including Sequential Organ Failure Assessment (SOFA) scores.
Main Results:
- 32.3% of patients were successfully weaned from MV.
- Higher median age and a greater proportion of male patients were observed in the weaning failure group.
- Respiratory causes for ICU admission (OR 3.98) and high SOFA scores on day 21 (OR 1.47) were significant predictors of weaning failure.
- The SOFA score on day 21 demonstrated good predictive value (AUC 0.77) for weaning failure.
Conclusions:
- Respiratory causes of ICU admission are associated with a higher risk of weaning failure in PMV patients.
- Elevated SOFA scores on day 21 of MV are a significant predictor of weaning failure.
- These findings can aid in risk stratification and management of patients requiring prolonged mechanical ventilation.
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