PURPOSE: Prolonged ventilation and extubation failure are associated with increased morbidity , mortality and economic burden. We assessed the effect of hemoglobin levels on outcomes in mechanically ventilated patients.
METHODS: Charts of 100 consecutive adult patients intubated for more than 12 hours in Medical Intensive Care Unit(MICU) of an academic hospital were analyzed. Effect of hemoglobin (Hgb) level at baseline (stable preadmission Hgb: Hgb-baseline), at the time of intubation (Hgb-intubation)and just prior to extubation (Hgb-extubation) on outcomes was assessed. Extubation success was defined as no need to reintubate within 72 hours of liberation from the ventilator.
RESULTS: The mean age of the participants was 67.12 ± 9.7 years, (Body Mass Index (BMI) 29 ± 9.04 kg/m2, APACHE score 24 ± 5.87. Hgb-baseline, Hgb-intubation and Hgb-extubation levels were 12.9 ± 1.94, 11.47 ± 2.51 and 10.59 ± 2.09 g/dl respectively. Average duration of mechanical ventilation was 10.34 ± 12.92 days, ICU length of stay was 12.39 ± 12.13 days. One month mortality was 45.5% and 6-month mortality was 54.5%.Successful extubation was achieved in 70%, the odds being higher with increasing Hgb-baseline (OR=1.34, CI 1.04-1.73, p=0.02) and lower with increasing age (OR=0.94, CI 0.90-0.99, p=0.04), independent of APACHE score. The ventilator duration was independently associated with blood transfusion (t=2.23, p=0.028) and inversely associated with Hgb-extubation (t=-3.12, p=0.002). The odds of receiving tracheostomy were higher in COPD (OR =2.87, CI 1.094-7.53, p=0.032) and lower with increasing Hgb-extubation (OR=0.73, CI 0.55-0.96, p=0.022). Odds of mortality were higher with increasing age (OR=1.05, CI 1.004-1.107, p=0.04) and increasing APACHE score (OR=1.14, CI 1.05-1.24, p=0.002). There was no independent effect of hemoglobin on mortality.
CONCLUSION: Lower hemoglobin levels in mechanically ventilated patients are associated with worse outcomes such as extubation failure and prolonged ventilation. However, blood transfusions seem to have an independent adverse impact on duration of mechanical ventilation.
CLINICAL IMPLICATIONS: Practices and therapies other than transfusion need to be assessed for improving outcomes in mechanically ventilated patients.
DISCLOSURE: Sandeep Chowdhary, No Financial Disclosure Information; No Product/Research Disclosure Information