Weaning critically ill patients from mechanical ventilation: A prospective cohort study

J Crit Care. 2015 Aug;30(4):862.e7-13. doi: 10.1016/j.jcrc.2015.04.001. Epub 2015 Apr 16.

Abstract

Purpose: A proposal was made at the International Consensus Conference to classify weaning of patients in intensive care units from mechanical ventilation into simple, difficult, and prolonged weaning groups based on the difficulty and length of the weaning process. The objective of the present study was to determine the incidence and outcome of weaning according to these new categories.

Methods: We examined the weaning of patients in intensive care units from mechanical ventilation in a prospective multicenter cohort study.

Results: In total, 343 patients were included in the final analysis. Simple, difficult, and prolonged weaning occurred in 200 (58%), 99 (29%), and 44 (13%) patients, respectively. Hospital mortality rates were higher for patients in the prolonged weaning group than in the simple and difficult weaning groups. Multivariate analysis revealed that a lower Glasgow Coma Scale score (P < .014) and hypercapnia at the beginning of the first spontaneous breathing trial (P = .038) were independent predictors of prolonged weaning.

Conclusions: Patients who experienced prolonged weaning had significantly higher mortality rates than patients who experienced either simple or difficult weaning. A lower Glasgow Coma Scale score and hypercapnia at the beginning of the weaning process were independent risk factors for prolonged weaning.

Keywords: Epidemiology; Intensive care unit; Ventilation; Weaning.

Publication types

  • Clinical Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Critical Illness*
  • Female
  • Glasgow Coma Scale
  • Hospital Mortality
  • Humans
  • Hypercapnia / epidemiology*
  • Incidence
  • Intensive Care Units
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prospective Studies
  • Respiration, Artificial / methods
  • Respiratory Insufficiency / therapy*
  • Risk Factors
  • Time Factors
  • Ventilator Weaning / methods
  • Ventilator Weaning / statistics & numerical data*