Characteristics and Outcomes of Ventilated Patients According to Time to Liberation from Mechanical Ventilation

Peñuelas, Óscar; Frutos‐Vivar, Fernando; Fernández, Cristina; Anzueto, Antonio; Epstein, Scott K.; Apezteguía, Carlos; González, Marco; Nin, Nicolás; Raymondos, Konstantinos; Tomicić, Vinko; Desmery, Pablo; Arabi, Yaseen M.; Pelosi, Paolo; Kuiper, Michael; Jibaja, Manuel; Matamis, Dimitros; Ferguson, Niall D.; Esteban, Andrés

doi:10.1164/rccm.201011-1887oc

Cited by 283 publications

(211 citation statements)

References 20 publications

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“…Among the reasons for ICU admission, 66% of the patients had respiratory causes, and most of them were diagnosed with pneumonia in this study. A previous study showed that the incidence of chronic pulmonary diseases, with exception to COPD, postoperative acute respiratory failure, and pneumonia, was associated with difficult and prolonged weaning in patients with MV (27). COPD was not associated with weaning failure following a multivariate analysis in the present study.…”

Section: Discussionsupporting

confidence: 43%

Clinical factors associated with weaning failure in patients requiring prolonged mechanical ventilation

Shin¹,

Chang²,

Ahn³

et al. 2017

J. Thorac. Dis.

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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). 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, 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.

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Section: Discussionsupporting

confidence: 43%

Clinical factors associated with weaning failure in patients requiring prolonged mechanical ventilation

Shin¹,

Chang²,

Ahn³

et al. 2017

J. Thorac. Dis.

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“…In this analysis, 2,714 patients were successfully discontinued over the 28 day study period. 23 Fifty-five percent were simple discontinuation, 39% were difficult discontinuation, and 6% were prolonged discontinuation. Not surprisingly, patients needing prolonged discontinuation processes were sicker and had longer stay and higher mortality than the simple discontinuation patients.…”

Section: Scope Of the Problemmentioning

confidence: 99%

The Ventilator Discontinuation Process: An Expanding Evidence BaseDiscussion

MacIntyre

2013

Respir Care

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The ventilator discontinuation process is an essential component of overall ventilator management. Undue delay leads to excess stay, iatrogenic lung injury, unnecessary sedation, and even higher mortality. On the other hand, premature withdrawal can lead to muscle fatigue, dangerous gas exchange impairment, loss of airway protection, and also a higher mortality. Continued ventilator dependence can be a result of persistent illness or can be a result of poor management. It is obviously important for the clinician to be able to assess both of these issues. An evidence-based task force has recommended regular assessments focusing on the causes of ventilator dependence, regular assessments for evidence of disease stability/reversal, use of regular spontaneous breathing trials (SBTs) as the primary assessment tool for ventilator discontinuation potential, use of separate assessments to evaluate the need for an artificial airway in patients tolerating the SBT, and the use of comfortable, interactive ventilator modes (that do not need to be "weaned") in between regular SBTs. More recent developments have focused on the importance of linking sedation reduction protocols to ventilator discontinuation protocols. Patients with repeated SBT failures are often considered to require prolonged mechanical ventilation (PMV). These patients often receive tracheostomies and are probably better managed with more gradual reductions in support and gradually lengthened spontaneous breathing periods. PMV patients have a high 1-year mortality, and many may ultimately require lifelong support. This evidence base is growing, but the earlier guidelines are standing the test of time. Indeed, practice patterns are evolving in accordance with them. Nevertheless, there is still room for improvement, and further clinical studies, especially in the patient requiring PMV, are needed.

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“…Severity of illness has been associated with prolonged weaning, longer duration of mechanical ventilation, and need for a tracheostomy. 17 Timing of tracheostomy after intubation was significantly longer in patients who had an infection before the tracheostomy. The infection most likely impaired weaning from mechanical ventilation, necessitating prolonged ventilatory support and causing difficulty in weaning.…”

Section: Discussionmentioning

confidence: 97%

Comparison of Respiratory Infections before and after Percutaneous Tracheostomy

Sole

Talbert

Penoyer

et al. 2014

American Journal of Critical Care

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Background A tracheostomy is often performed when patients cannot be weaned from mechanical ventilation. Respiratory infections (ventilator-associated pneumonia and infection of the lower respiratory tract) complicate the course of hospitalization in patients receiving mechanical ventilation. Objectives To evaluate respiratory infections before and after a percutaneous tracheostomy and to describe their outcomes. Methods Medical records of adults who had percutaneous tracheostomy during a 1-year period at a tertiary care hospital in the southeastern United States were reviewed retrospectively. Results Data for 322 patients were analyzed. Patients were predominately male (63.0%) and white (57.8%), with a mean age of 57.4 years. Ventilator-associated pneumonia or infection of the lower respiratory tract was identified in 90 patients (28.0%); the majority of infections were lower respiratory infections. Of all infections, 52% occurred before the tracheostomy, and 48% occurred after the procedure. Respiratory infections were associated with longer stays and higher costs, which were significantly higher in patients in whom the infection developed after the tracheostomy. Gram-negative organisms were responsible for the majority of infections. Conclusions Data related to respiratory infections that occurred before a tracheostomy were similar to data related to infections that occurred after a tracheostomy. Most infections were classified as lower respiratory infection rather than pneumonia. Infection, before or after a tracheostomy, resulted in longer stays and higher costs for care. Interventions focused on preventing infection before and after tracheostomy are warranted.

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Characteristics and Outcomes of Ventilated Patients According to Time to Liberation from Mechanical Ventilation

Cited by 283 publications

References 20 publications

Clinical factors associated with weaning failure in patients requiring prolonged mechanical ventilation

Clinical factors associated with weaning failure in patients requiring prolonged mechanical ventilation

The Ventilator Discontinuation Process: An Expanding Evidence BaseDiscussion

Comparison of Respiratory Infections before and after Percutaneous Tracheostomy

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