A new classification of patients based on the duration of liberation of mechanical ventilation has been proposed.To analyze outcomes based on the new weaning classification in a cohort of mechanically ventilated patients.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.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], 1.001–1.02), 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 ¼ 0.08),tracheostomy (P ¼ 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\%.

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

SEVERGNINI, PAOLO
2011-01-01

Abstract

A new classification of patients based on the duration of liberation of mechanical ventilation has been proposed.To analyze outcomes based on the new weaning classification in a cohort of mechanically ventilated patients.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.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], 1.001–1.02), 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 ¼ 0.08),tracheostomy (P ¼ 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\%.
2011
http://dx.doi.org/10.1164/rccm.201011-1887OC
Acute Disease, Adult, Asthma; therapy, Chronic Disease, Cohort Studies, Follow-Up Studies, Humans, Intensive Care Units, Intubation, Length of Stay, Logistic Models, Lung Diseases; mortality/physiopathology/therapy, Odds Ratio, Pneumonia; therapy, Positive-Pressure Respiration, Prospective Studies, Pulmonary Disease; Chronic Obstructive; therapy, Respiration; Artificial, Retreatment, Risk Assessment, Severity of Illness Index, Time Factors, Tracheostomy, Treatment Outcome, Ventilator Weaning; classification/methods
O., Peñuelas; F., Frutos Vivar; C., Fernández; A., Anzueto; S. K., Epstein; C., Apezteguía; M., González; N., Nin; K., Raymondos; V., Tomicic; P., Desmery; Y., Arabi; P., Pelosi; M., Kuiper; M., Jibaja; D., Matamis; N. D., Ferguson; A., Esteban; Severgnini, Paolo
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/1788721
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