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

Lin Pu; Bo Zhu; Li Jiang; Bin Du; Xi Zhu; Ang Li; Gang Li; Zhongjie He; Wei Chen; Penglin Ma; Jianguo Jia; Yuan Xu; Jianxin Zhou; Long Qin; Qingyuan Zhan; Wenxiong Li; Qi Jiang; Meiping Wang; Ran Lou; XiuMing Xi

doi:10.1016/j.jcrc.2015.04.001

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.

Authors

Lin Pu¹, Bo Zhu², Li Jiang³, Bin Du⁴, Xi Zhu⁵, Ang Li⁶, Gang Li⁷, Zhongjie He⁸, Wei Chen⁹, Penglin Ma¹⁰, Jianguo Jia¹¹, Yuan Xu¹², Jianxin Zhou¹³, Long Qin¹⁴, Qingyuan Zhan¹⁵, Wenxiong Li¹⁶, Qi Jiang¹⁷, Meiping Wang¹⁸, Ran Lou¹⁹, XiuMing Xi²⁰

Affiliations

¹ Department of Critical Care Medicine, Capital Medical University, ICU Fu Xing Hospital, Beijing 10038, China; Department of Critical Care Medicine, Capital Medical University, ICU Beijing Ditan Hospital, Beijing 100015, China. Electronic address: [email protected].
² Department of Critical Care Medicine, Capital Medical University, ICU Fu Xing Hospital, Beijing 10038, China. Electronic address: [email protected].
³ Department of Critical Care Medicine, Capital Medical University, ICU Fu Xing Hospital, Beijing 10038, China. Electronic address: [email protected].
⁴ Medical Intensive Care Unit, MICU Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: [email protected].
⁵ Department of Critical Care Medicine, ICU Peking University Third Hospital, Beijing 100191, China. Electronic address: [email protected].
⁶ Department of Critical Care Medicine, Capital Medical University, ICU Beijing Friendship Hospital, Beijing 100050, China.. Electronic address: [email protected].
⁷ Department of Critical Care Medicine, ICU China-Japan Friendship Hospital, Beijing 100029, China. Electronic address: [email protected].
⁸ Department of Critical Care Medicine, ICU The First Affiliated Hospital of General Hospital of People's Liberation Army, Beijing 100048, China. Electronic address: [email protected].
⁹ Department of Critical Care Medicine, Capital Medical University, ICU Beijing Shijitan Hospital, Beijing 100038, China. Electronic address: [email protected].
¹⁰ Department of Critical Care Medicine, ICU The 309th Hospital of Chinese People's Liberation Army, Beijing 100094, China. Electronic address: [email protected].
¹¹ Surgical Intensive Care Unit, Capital Medical University, SICU Xuan Wu Hospital, Beijing 100053, China. Electronic address: [email protected].
¹² Department of Critical Care Medicine, Capital Medical University, ICU Beijing Tong Ren Hospital, Beijing 100730, China. Electronic address: [email protected].
¹³ Department of Critical Care Medicine, Capital Medical University, ICU Beijing Tian Tan Hospital, Beijing 100050, China. Electronic address: [email protected].
¹⁴ Department of Critical Care Medicine, ICU Beijing Haidian Hospital, Beijing 100080, China. Electronic address: [email protected].
¹⁵ Department of Respiratory, China-Japan Friendship Hospital, Beijing 100029, China. Electronic address: [email protected].
¹⁶ Surgical Intensive Care Unit, Capital Medical University, SICU Beijing Chao-Yang Hospital, Beijing 100020, China. Electronic address: [email protected].
¹⁷ Department of Critical Care Medicine, Capital Medical University, ICU Fu Xing Hospital, Beijing 10038, China. Electronic address: [email protected].
¹⁸ Department of Critical Care Medicine, Capital Medical University, ICU Fu Xing Hospital, Beijing 10038, China. Electronic address: [email protected].
¹⁹ Department of Critical Care Medicine, Capital Medical University, ICU Fu Xing Hospital, Beijing 10038, China. Electronic address: [email protected].
²⁰ Department of Critical Care Medicine, Capital Medical University, ICU Fu Xing Hospital, Beijing 10038, China. Electronic address: [email protected].

PMID: 25957496
DOI: 10.1016/j.jcrc.2015.04.001

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*