Prevalence of and Risk Factors for Mechanical Ventilation Reinstitution in Patients Weaned From Prolonged Mechanical Ventilation

Abstract

BACKGROUND: Prolonged mechanical ventilation is increasingly common in ICUs. Although a consensus conference defined weaning success in this patient population, few studies have used this definition. A clear definition of successful weaning is useful to assess clinical and epidemiological outcomes, facilitate clinical decision making, and set goals of care. The aims of our study were to describe the prevalence of reinstitution of mechanical ventilation within 28 d in patients successfully weaned according to our institution criterion (ie, weaning success as per consensus guidelines), to describe reasons to reestablish mechanical ventilation, and to identify associated factors. METHODS: An observational, analytical, cross-sectional study was conducted at a weaning and rehabilitation center. All patients liberated from mechanical ventilation (ie, no ventilatory support for 7 d) were included as subjects. Requirement of and reasons for reinstitution of mechanical ventilation within 28 d of weaning were recorded. RESULTS: A total of 639 tracheostomized subjects were analyzed. Of these, 219 (34%) were weaned, and 15 were eliminated due to lack of data. Of the remaining 204 subjects, 42 (21%) were reconnected to mechanical ventilation within 28 d. Sepsis accounted for 64% of reconnections. In the multivariate analysis, neurological comorbidity (adjusted odds ratio 5.1 [95% CI 2.3-11.1]) and delayed weaning (> 7 d after admission) (adjusted odds ratio 2.37 [95% CI 1.1-5.3]) were independently associated with reinstitution of mechanical ventilation within 28 d of weaning. The synergistic effect of both variables showed an adjusted odds ratio of 5.35 (95% CI 2.4 -11.4). CONCLUSIONS: Reinstitution of mechanical ventilation within 28 d is a common event in patients considered to be weaned: 1 in 5 of such patients requires reconnection to mechanical ventilation, with sepsis being the most prevalent cause. Neurological comorbidity and delayed weaning are risk factors associated with reestablishment of mechanical ventilation. The presence of more than one risk factor increases the association with reinstitution of mechanical ventilation within 28 d of weaning.

Explainable Machine Learning to Predict Successful Weaning Among Patients Requiring Prolonged Mechanical Ventilation: A Retrospective Cohort Study in Central Taiwan

“…Patients requiring PMV is currently a growing issue in Taiwan as well as the world. The advance of critical care has led to not only a steady decrease of the mortality rate among critically ill patients in the past two decades but also an unexpected increase in the number of patients requiring PMV (21,22). Hill et al, conducting a Canadian population-based cohort study through investigating 213,680 patients who received MV between 2002 and 2013, reported that 5.4% (11,594) of these patients required PMV (23).…”

Biosignal-Based Digital Biomarkers for Prediction of Ventilator Weaning Success

“…Although many predictive indices and clinical tools are already in use [1,[13][14][15][16][17][18][19][20][21][22], >20% of the patients who have fulfilled the classic weaning criteria require reintubation [14,[23][24][25]. The predictive performance decreases in patients with multi-organ dysfunction, older age, prolonged MV, and severe illness [26][27][28][29][30][31]. The lack of reliable weaning parameters is related to the heterogeneity of critically ill patients and their ever-changing clinical courses [32][33][34][35].…”

Factores de riesgo asociados al destete ventilatorio fallido en pacientes sépticos en una unidad de cuidado intensivo: estudio de casos y controles

“…También este estudio reportó una asociación significativa entre el tiempo de ventilación mecánica invasiva mayor a 7 días con el destete ventilato- han sido publicados por otros autores (24). Si se tiene en cuenta que la ventilación mecánica es instaurada para contrarrestar la falla ventilatoria inducida por la sepsis, también se debe visibilizar que su prolongación genera un impacto deletéreo sobre la función del diafragma como resultado de la regulación positiva de citosinas pro inflamatorias y estrés oxidativo que comparte con la sepsis, estos eventos sinérgicos asociados aumentan el riesgo de debilidad adquirida en UCI a su vez incrementaran la dependencia al soporte ventilatorio dificultando el destete ventilatorio.…”