Factors associated with failed weaning from mechanical ventilation in adults on ventilatory support during 48 hours or more
Failed weaning from mechanical ventilation (MV) has been reported in a proportion ranging from 10% to 20% of patients requiring ventilation support; this population has a longer duration of MV and risk of mortality.
To evaluate factors associated with failed weaning from MV.
Descriptive study of a cohort of 139 patients, who participated in the clinical trial. Efficacy of respiratory muscle training (RMT) for weaning from MV in patients on MV during 48 hours or more. Clinical and sociodemographic exposure variables were measured. The outcome variable evaluated was failed weaning from MV. A descriptive analysis was carried out, and relative risks (RRs) were estimated using the Poisson regression. Single and multiple models were built.
The incidence of failed weaning was 24.09%, 95% confidence interval (CI) 16.83 to 31.33. Independent associated factors were the respiratory system as the main compromised system upon admission to the intensive care unit (RR: 3.89; 95% CI 1.33-11.37; P = 0.01) and the Apache score (RR 0.96; 95% CI 0.920.98; P = 0.02). Modifiable factors such as pulmonary rehabilitation interventions, physical rehabilitation, RMT, and specific ventilatory strategies showed no association (P >0.05).
There are non-modifiable factors related to failed weaning from MV in adults. Patients admitted to the intensive care unit with the respiratory system as the main system compromised have a higher risk of failed weaning; modifiable factors were not found to be associated with failed weaning in the population studied.
2. Lone NI, Walsh TS. Prolonged mechanical ventilation in critically ill patients: epidemiology, outcomes and modelling the potential cost consequences of establishing a regional weaning unit. Crit Care 2011;15:R102.
3. MacIntyre NR, Epstein SK, Carson S, et al. Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference. Chest 2005;128:3937-3954.
4. Esteban A, Anzueto A, Frutos F, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 2002;287:345-355.
5. Esteban A, Frutos-Vivar F, Muriel A, et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 2013;188:220-230.
6. Boles J-M, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J 2007;29:1033-1056.
7. Brochard L, Rauss A, Benito S, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 1994;150:896-903.
8. Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996;335:1864-1869.
9. Esteban A, Alia I, Gordo F, et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation: the Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 1997;156:459-465.
10. Esteban A, Alia I, Tobin MJ, et al. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation: Spanish Lung Failure Collaborative Group. AmJ Respir Crit Care Med 1999;159:512-518.
11. Barbier F, Andremont A, Wolff M, et al. Hospital-acquired pneumonia and ventilator-associated pneumonia: recent advances in epidemiology and management. Curr Opin Pulm Med 2013;19:216-228.
12. Niederman M, Craven D, Bonten M. American Thoracic Society; Infectious Diseases Society of America Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. AmJ Respir Crit Care Med 2005;171:388-416.
13. Touat L, Fournier C, Ramon P, et al. Intubation-related tracheal ischemic lesions: incidence, risk factors, and outcome. Intensive Care Med 2013;39:575-582.
14. Cox CE, Carson SS, Lindquist JH, et al. Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study. Crit Care 2007;11:R9.
15. Garrigues , Lefrant JY, Bazin JB, et al. The cost per day of intensive care units (ICU) in France: The Crrea Study. Value Health 2011;14: A346-A347.
16. Wagner DP. Economics of prolonged mechanical ventilation. Am Rev Respir Dis 1989;140 (2_pt_2):S14-S18.
17. Coplin WM, Pierson DJ, Cooley KD, et al. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med 2000;161:1530-1536.
18. Khamiees M, Raju P, DeGirolamo A, et al. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 2001;120:1262-1270.
19. Smina M, Salam A, Khamiees M, et al. Cough peak flows and extubation outcomes. Chest 2003;124:262-268.
20. Frutos-Vivar F, Ferguson ND, Esteban A. Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 2006;130:1664-1671.
21. Sandoval L, Casas I, Wilches E, et al. Efficacy of respiratory muscle training in weaning of mechanical ventilation in patients with mechanical ventilation for 48 hours or more: A Randomized Controlled Clinical Trial. Medicina Intensiva. Forthcoming 2018.
22. Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients. JAMA 2003;289:2983-2991.
23. Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002;166:1338-1344.
24. Szklo M, Nieto FJ. Epidemiologia Intermedia, Conceptos y aplicaciones. Segunda edición 2006.
25. Yang KL. Inspiratory pressure/maximal inspiratory pressure ratio: a predictive index of weaning outcome. Intensive Care Med 1993;19:204-208.
26. SIlVa PE. Inspiratory muscle training in mechanical ventilation: suitable protocols and endpoints, the key to clear results-a critical review. ASSOBRAFIR Ciência 2015;6:21-30.
27. Romer LM, McConnell AK. Specificity and reversibility of inspiratory muscle training. Med Sci Sports Exerc 2003;35:237-244.
28. Capdevila X, Perrigault P-F, Ramonatxo M, et al. Changes in breathing pattern and respiratory muscle performance parameters during difficult weaning. Crit Care Med 1998;26:79-87.
29. Carlucci A, Ceriana P, Prinianakis G, et al. Determinants of weaning success in patients with prolonged mechanical ventilation. Crit Care 2009;13:R97.
30. Vallverdu I, Calaf N, Subirana M, et al. Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial in patients weaning from mechanical ventilation. Am J Resp Crit Med 1998;158:1855-1862.
31. Jubran A, Tobin MJ. Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. Am J Respir Crit Care Med 1997;155:906-915.
The Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.) is the owner of all copyrights to any articles published in the journal. Published manuscripts become the permanent property of S.C.A.R.E. and may not be published elsewhere without written permission. S.C.A.R.E. keeps the right to use these manuscripts in any form, including print, video, audio and digital.
Creative Commons License
Open-access articles can be read, downloaded and shared on a free basis upon publication. The Journal publishes all articles under the CCBY- NC-ND license. Attribution-NonCommercial-NoDerivs: CC BY- NC-ND. Of the six main licenses, this is the most restrictive because it only allows others to download and share articles as long as they give credit to the author, but they cannot in any way change the paper or use it commercially.