Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation
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 prolonged weaning.Variables associated with prolonged weaning(.7d)were: severity at admission (odds ratio [OR] per unit of Simplified Acute Physiology Score II, 1.01; 95% confidence interval [CI], 1.001â€“1.02), duration of mechanical ventilation before first attempt of weaning (OR per day, 1.10; 95% CI, 1.06â€“1.13), chronic pulmonary disease other than chronic obstructive pulmonary disease (OR,13.23; 95% CI, 3.44â€“51.05), pneumonia as the reason to start mechanical ventilation (OR, 1.82; 95% CI, 1.07â€“3.08), and level of positive end-expiratory pressure applied before weaning (OR per unit,1.09; 95% CI, 1.04â€“1.14). The prolonged weaning group had a nonsignificant trend toward a higher rate of reintubation (P Â¼ 0.08),tracheostomy (P Â¼ 0.15), and significantly longer length of stay and higher mortality in the intensive care unit (OR for death, 1.97;95%CI, 1.17â€“3.31). The adjusted probability of death remained constant until Day 7, at which point it increased to 12.1%.
Peñuelas O, Frutos-Vivar F, Fernández C, Anzueto A, Epstein SK, Apezteguía C, González M, Nin N, Raymondos K, Tomicic V, Desmery P, Arabi Y, Pelosi P, Kuiper M, Jibaja M, Matamis D, Ferguson ND, Esteban A; Ventila Group [Group Member-Steingrub J]. Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation Am J Respir Crit Care Med 2011 Aug;184(4):430-7.