Critical Care: Critical Care: Mechanical Ventilation |

Predictors and Outcomes of Prolonged Weaning Among Intubated Patients on Mechanical Ventilation Admitted to the Intensive Care Unit FREE TO VIEW

Andre Awaloei, MD
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St. Luke's Medical Center - Quezon City, Quezon, Philippines

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A162. doi:10.1016/j.chest.2016.02.168
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SESSION TITLE: Critical Care: Mechanical Ventilation

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: Weaning is an essential part of critically ill patients who are on mechanical ventilation. Recently a new classification was revised categorizing weaning into simple, difficult and prolonged. It was recognized that some patients are easily weaned off and others require a more prolonged duration. This study aimed to determine the factors that are associated with prolonged weaning and to determine if these factors can predict patients who will undergo prolonged weaning.

METHODS: A total of 70 intubated patients admitted to the Intensive Care Unit (ICU), were successfully weaned and divided into difficult (49, 70%) and prolonged weaning (21, 30%). Characteristics and outcomes were compared among the two groups and factors associated with prolonged weaning were determined.

RESULTS: Results showed the following factors are associated with prolonged weaning: Acute Physiology and Chronic Health Evaluation II score >15 (p=0.036); Glasgow Coma Scale <10 (p=0.026); decreased sensorium as the indication for mechanical ventilation initiation (p=0.023); presence of pneumonia or isolates in endotracheal aspirate (p=0.002); presence of other complications such as ventilator associated pneumonia (p<0.0001), respiratory (p=0.008) and cardiovascular failure (p=0.047); more than 5 days on mechanical ventilation prior to start of weaning (p=0.021) and those who were weaned using synchronous intermittent mandatory ventilation mode (p=0.007) and pressure support ventilation mode (p=0.013).

CONCLUSIONS: Factors were identified associated with prolonged weaning, however, when subjected to multiple regression analysis, these factors do not significantly predict prolonged weaning. Prolonged weaning is associated with the following outcomes: increased ICU stay and higher rate of tracheostomy.

CLINICAL IMPLICATIONS: Prolonged mechanical ventilation is associated with higher rate of reintubation, tracheostomy rate, longer ICU stay and higher mortality. About 10% of ventilated patients who were successfully weaned had prolonged weaning. Identification and correction of factors associated with prolonged weaning may change the outcome and prognosis of these patients. In addition, early intervention such as tracheostomy is likely to benefit these patients.

DISCLOSURE: The following authors have nothing to disclose: Andre Awaloei

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