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Mortality study in patients at weaning from mechanical ventilation.

J A Santos Rodriguez1, J Mancebo Cortés1

  • 1Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.

Medicina Intensiva
|September 3, 2019
PubMed
Summary

This study found that mortality risk was similar across different patient groups after a spontaneous breathing test. Prolonged mechanical ventilation did not significantly impact survival outcomes in the intensive care unit (ICU).

Keywords:
Cox regressionDesconexión de la ventilación mecánicaDesenlacesLogistic regressionOutcomesRegresión de CoxRegresión logísticaWeaning from mechanical ventilation

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Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Intensive Care

Background:

  • Invasive mechanical ventilation is a critical intervention for patients in intensive care units (ICUs).
  • Understanding mortality predictors in mechanically ventilated patients is essential for improving patient outcomes.
  • The WIND study classification stratifies patients based on risk, but its impact on mortality requires further investigation.

Purpose of the Study:

  • To investigate mortality rates in intensive care unit (ICU) and hospital settings among patients requiring invasive mechanical ventilation.
  • To evaluate the association between the WIND study classification and patient mortality.
  • To analyze the impact of spontaneous breathing tests and ventilation duration on survival.

Main Methods:

  • A prospective, 9-month observational cohort study was conducted in a Department of Intensive Care Medicine.
  • 266 consecutive patients requiring invasive mechanical ventilation were enrolled and followed until hospital discharge or death.
  • Data collected included ventilation duration, spontaneous breathing test timing, ICU/hospital length of stay, and the Simplified Acute Physiology Score 3 (SAPS-3).

Main Results:

  • Patients were categorized into four WIND classification groups (0-3), with group 3 having the highest crude hospital mortality (odds ratio 4.0 vs. group 1).
  • However, Cox regression analysis, considering exposure time, revealed no significant differences in mortality among the WIND groups (hazard ratio 1.6 vs. group 1).
  • The probability of mortality was found to be similar across different patient groups after at least one spontaneous breathing test.

Conclusions:

  • The WIND classification, while indicating higher crude mortality in group 3, did not show a significant independent association with mortality when adjusted for exposure time.
  • Mortality risk appears comparable among different patient groups after successful spontaneous breathing trials, regardless of their initial risk classification.
  • This suggests that factors beyond initial risk stratification, such as ventilation duration and patient response to weaning, play a crucial role in determining outcomes for mechanically ventilated patients.