Impact of frailty on protocol‐based weaning from mechanical ventilation in patients with sepsis: a retrospective cohort study

Abstract

Aim: Frailty has been shown to be associated with prolonged mechanical ventilation (MV). However, due to limited physiological data, it has been unclear how frailty affects weaning from MV in septic patients subjected to a specific weaning protocol. Methods: This was a single-center retrospective cohort study. The study included patients with sepsis on MV who underwent protocol-based weaning between August 2015 and December 2018. Frailty was defined as a Clinical Frailty Scale score 4 or more. The association between frailty and weaning was evaluated. Results: Ninety-nine eligible patients were identified and categorized as frail (n = 67) or not frail (n = 32). The duration of MV was significantly longer in the frail group (8 days versus 5 days, P < 0.01). In multivariate analysis, frailty was independently associated with duration of MV (regression coefficient 17.97, 95% confidence interval 1.77-34.17) and successful weaning (hazard ratio 0.60, 95% confidence interval 0.36-1.00). There was no significant between-group difference in duration until the first separation attempt or reintubation rate. Respiratory failure was significantly more common in the frail group as a cause of weaning failure, whereas airway failure was common in both groups. Conclusion: Frailty was independently associated with a longer duration of MV in patients with sepsis who underwent protocolbased weaning. Frail patients were more likely to fail spontaneous breathing trials than nonfrail patients during the weaning process, although the risk after extubation was similar.

Obesity Paradox and Functional Outcomes in Sepsis: A Multicenter Prospective Study

“…Many patients with sepsis are at risk of severe loss of muscle mass and quality ( 16 , 34 ). Patients who become frail after sepsis may have an increased risk of extubation failure, may more frequently require a tracheostomy, and may have difficulties weaning from a ventilator ( 35 , 36 ). Obesity can prevent muscle wasting and weakness in sepsis and demonstrates a different metabolic response to sepsis in comparison with lean patients by preserving muscle mass while losing fat mass ( 37 , 38 ).…”

The Regulation of Neutrophil Migration in Patients with Sepsis: The Complexity of the Molecular Mechanisms and Their Modulation in Sepsis and the Heterogeneity of Sepsis Patients

“…Furthermore, preexisting clinical frailty is associated with worse outcomes, including increased mortality for elderly sepsis patients [ 382 ], and frailty together with age and disease severity are identified as predictors of long-term mortality in very old intensive care patients with sepsis [ 383 ]. Finally, a longer duration of mechanical ventilation in frail sepsis patients who underwent protocol-based weaning was also observed [ 384 ].…”

How Should We Use Frailty Evaluation for Patients With Sepsis in the Clinical Practice?

“…We believe that the presence or absence of DNI orders should therefore be carefully adjusted for, so that frail patients do not receive inadequate treatment based on overly pessimistic predicted outcomes. In this regard, we recently reported that frailty was associated with delay in ventilator weaning in patients with sepsis (4). Given that our frail patients frequently presented with respiratory failure, we speculate that they were more ventilator-dependent due not only to limitations placed on their treatment but also to respiratory muscle weakness and atrophy.…”