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Critical Care |

The Relationship Between Obesity and Weaning From Prolonged Mechanical Ventilation in Survivors of Critical Illness

Vinay Srinivasan, MD; Anita Tammara, MD; Avelino Verceles, MD
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University of Maryland Medical Center, Baltimore, MD


Chest. 2015;148(4_MeetingAbstracts):321A. doi:10.1378/chest.2259193
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Abstract

SESSION TITLE: Mechanical Ventilation Poster Discussion

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Tuesday, October 27, 2015 at 02:45 PM - 04:15 PM

PURPOSE: Obesity (BMI ≥ 30 kg/m2) has been associated with an increased length of mechanical ventilation and failure to wean in the acute care setting. However, the relationship between obesity and length of time to wean in intensive care unit (ICU) survivors who require prolonged mechanical ventilation (PMV) has not been well described. We hypothesized that obese patients who require prolonged mechanical ventilation would have similar outcomes with respect to ventilator days and weaning success as the acute, critically ill population.

METHODS: Single center, retrospective cohort study of 55 patients who required long term weaning from PMV at a university affiliated long term care (LTC) hospital. All patients met the definition of requiring mechanical ventilation for ≥ 14 days, underwent tracheostomy, and survived an ICU admission. Patients were stratified into 3 groups based on their BMI: ≤ 20 kg/m2, > 20 and < 30 kg/m2 and ≥ 30 kg/m2. Demographics were recorded and statistical analysis was performed to assess for similarity across all three groups. Ventilator days and 60 day weaning success were assessed as outcomes.

RESULTS: The mean age of the cohort was 61.8 ± 13.8 years and mean BMI was 34.9 ± 15.5 kg/m2. The cohort consisted of 36 males (65%) and 19 females (35%). No differences in Charlson Comorbidity Index (CCI) were found among the BMI groups (4.5 vs. 4.2 vs. 4.2, p = 0.94). 38 patients (69%) were successfully weaned from PMV while 17 (31%) failed; 67% of patients from the 1st group, 74% from the 2nd group, and 67% from the 3rd group weaned successfully. Those that weaned spent an average of 36.4 ± 17.6 days receiving prolonged mechanical ventilation. Mean number of vent days was 38.0 ± 18.4, 36.4 ± 17.3, and 38.2 ± 22.7 days across the 3 BMI groups respectively. No difference in mean number of vent days was found across the three BMI groups (p = 0.96). Analysis demonstrated a poor correlation between BMI with time to weaning and BMI with weaning success from prolonged mechanical ventilation.

CONCLUSIONS: As opposed to weaning from mechanical ventilation in the acute setting, obesity has a poor correlation with length of time to wean and with weaning success in survivors of critical illness receiving prolonged mechanical ventilation.

CLINICAL IMPLICATIONS: Given the prevalence of obesity in this patient population, further studies will address the correlation between obesity and other outcomes of mechanically ventilated ICU survivors including length of time at facility, discharge disposition, and mortality.

DISCLOSURE: The following authors have nothing to disclose: Vinay Srinivasan, Anita Tammara, Avelino Verceles

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