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

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%.