Predictors and pattern of weaning and long-term outcome of patients with prolonged mechanical ventilation at an acute intensive care unit in North India

Abstract

ObjectiveThis study aimed to examine the clinical characteristics, weaning pattern, and outcome of patients requiring prolonged mechanical ventilation in acute intensive care unit settings in a resource-limited country.MethodsThis was a prospective single-center observational study in India, where all adult patients requiring prolonged ventilation were followed for weaning duration and pattern and for survival at both intensive care unit discharge and at 12 months. The definition of prolonged mechanical ventilation used was that of the National Association for Medical Direction of Respiratory Care.ResultsDuring the one-year period, 49 patients with a mean age of 49.7 years had prolonged ventilation; 63% were male, and 84% had a medical illness. The median APACHE II and SOFA scores on admission were 17 and 9, respectively. The median number of ventilation days was 37. The most common reason for starting ventilation was respiratory failure secondary to sepsis (67%). Weaning was initiated in 39 (79.5%) patients, with success in 34 (87%). The median weaning duration was 14 (9.5 - 19) days, and the median length of intensive care unit stay was 39 (32 - 58.5) days. Duration of vasopressor support and need for hemodialysis were significant independent predictors of unsuccessful ventilator liberation. At the 12-month follow-up, 65% had survived.ConclusionIn acute intensive care units, more than one-fourth of patients with invasive ventilation required prolonged ventilation. Successful weaning was achieved in two-thirds of patients, and most survived at the 12-month follow-up.

Clinical features and outcomes of prolonged mechanical ventilation: a single-center retrospective observational study

“…In addition, previous studies have shown that PMV patients had a longer duration of MV, ICU stay, and hospital stay compared with those who did not. According to these studies, duration of MV among PMV patients was 29-51 days, ICU stay was 33-52 days, and hospital stay was 51-77 days [2,4,[12][13][14]20]. These studies were conducted in countries lacking the concept of weaning centers, and the results were consistent with those observed in our study.…”

“…Conversely, in countries such as Japan lacking weaning centers, patients who require PMV may occupy ICU beds in acute care hospitals for an extended period, thereby affecting the fair allocation of critical care resources [2,4,[12][13][14]. Furthermore, these patients place substantial loads on intensivists throughout the long period of the weaning trial.…”

Weaning from Invasive Ventilation in Specialist Centers Following Primary Weaning Failure

“…A comparison reveals that the success rate of this intervention is in the upper range (7,22). As in older studies, the most frequent causes of primary weaning failure included acutely exacerbated COPD or pneumonia (1,18,19,23).…”

“…Continued care of patients depending on weaning success NIV, non-invasive ventilation the course of primary weaning (16)(17)(18)(19)(20)(21). A comparison reveals that the success rate of this intervention is in the upper range (7,22).…”

Pressão positiva na ventilação mecânica invasiva e implicações renais em pacientes críticos

“…A pressão positiva, ao final da expiração (PEEP), na ventilação mecânica invasiva (VMI), pode provocar alterações neuro-hormonais em pacientes críticos, decorrentes da ativação do sistema neurovegetativo simpático, reninaangiotensina e supressão da liberação do peptídeo natriurético atrial, induzindo a retenção de líquidos e a diminuição do fluxo sanguíneo renal, potenciais causas de lesão renal aguda (LRA) (1) . Sendo assim, a identificação de mecanismos e/ou de fatores modificáveis pode ser útil, para melhor direcionar a gestão, além do processo de sistematização da assistência e segurança do paciente crítico com LRA (1)(2) .…”