Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation

Oscar Peñuelas, Fernando Frutos-Vivar, Cristina Fernández, Antonio Anzueto, Scott K. Epstein, Carlos Apezteguía, Marco González, Nicolas Nin, Konstantinos Raymondos, Vinko Tomicic, Pablo Desmery, Yaseen Arabi, Paolo Pelosi, Michael Kuiper, Manuel Jibaja, Dimitros Matamis, Niall D. Ferguson, Andrés Esteban

Research output: Contribution to journalArticlepeer-review

171 Scopus citations

Abstract

Rationale: A new classification of patients based on the duration of liberation of mechanical ventilation has been proposed. Objectives: To analyze outcomes based on the new weaning classification in a cohort of mechanically ventilated patients. Methods: Secondary analysis included 2,714 patients who were weaned and underwent scheduled extubation from a cohort of 4,968 adult patients mechanically ventilated for more than 12 hours. Measurements and Main Results: Patients were classified according to a new weaning classification: 1,502 patients (55%) as simple weaning, 1,058 patients (39%) as difficult weaning, and 154 (6%) as prolongedweaning. Variables associatedwith prolongedweaning(>7d) were: severity at admission (odds ratio [OR] per unit of Simplified Acute Physiology Score II, 1.01; 95% confidence interval [CI], 1.001-1.02), duration of mechanical ventilation before first attempt of weaning (OR per day, 1.10; 95% CI, 1.06-1.13), chronic pulmonary disease other than chronic obstructive pulmonary disease (OR, 13.23; 95% CI, 3.44-51.05), pneumonia as the reason to start mechanical ventilation (OR, 1.82; 95% CI, 1.07-3.08), and level of positive end-expiratory pressure applied before weaning (OR per unit, 1.09; 95% CI, 1.04-1.14). The prolonged weaning group had a nonsignificant trend toward a higher rate of reintubation (P = 0.08), tracheostomy (P = 0.15), and significantly longer length of stay and higher mortality in the intensive care unit (OR for death, 1.97; 95%CI, 1.17-3.31). The adjusted probability of death remained constant until Day 7, at which point it increased to 12.1%.

Original languageEnglish (US)
Pages (from-to)430-437
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume184
Issue number4
DOIs
StatePublished - Aug 15 2011

Keywords

  • Extubation
  • Mechanical ventilation
  • Outcome
  • Weaning

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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