Predictors of prolonged weaning among mechanically ventilated patients in respiratory intensive care unit
Background Weaning has been classified into simple, difficult, and prolonged. Objective The aim of this study was to assess predictors of prolonged weaning (PW) and survival in the respiratory ICU (RICU). Patients and methods Fifty-three patients admitted to RICU and requiring mechanical ventilation...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2019-01-01
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| Series: | Egyptian Journal of Chest Disease and Tuberculosis |
| Subjects: | |
| Online Access: | http://www.ejcdt.eg.net/article.asp?issn=0422-7638;year=2019;volume=68;issue=4;spage=526;epage=535;aulast=Mohammadien |
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| author | Hamdy A Mohammadien Mostafa I Ali Mona T Hussien Doaa G Hassanin |
| author_facet | Hamdy A Mohammadien Mostafa I Ali Mona T Hussien Doaa G Hassanin |
| author_sort | Hamdy A Mohammadien |
| collection | DOAJ |
| description | Background Weaning has been classified into simple, difficult, and prolonged.
Objective The aim of this study was to assess predictors of prolonged weaning (PW) and survival in the respiratory ICU (RICU).
Patients and methods Fifty-three patients admitted to RICU and requiring mechanical ventilation (MV) were included in the study. According to the classification of weaning, patients were categorized into simple [20 (37.7%)], difficult [20 (37.7%)], and PW [13 (24.5%)]. Factors associated with PW and outcomes were assessed.
Results Multiple factors were associated with PW: decreased serum Ca2+ (P<0.0001), Mg2+(P<0.0001), and albumin (P=0.001); increased urea (P=0.001), aspartate aminotransferase (P=0.0005), and alanine aminotransferase (P=0.0001); increased PaCO2 (P=0.04); decreased SaO2% (P<0.0001) at beginning of the first weaning trial; at least 2 comorbidities (P=0.02); increased duration of MV (P<0.0001); and increased ICU stay (P<0.0001). There was no significant association between PW and modes of MV (P=0.2); moreover, alveolar–arterial gradient decreased in patients with PW but was not significant (P=0.57). By multivariate analysis, PW was associated with low serum Mg2+ (odds ratio: 0.03, 95% confidence interval: 0.003–0.24, P=0.001), and SaO2% change (between baseline and first weaning trial) (odds ratio: 0.68, 95% confidence interval: 0.54–1.04, P=0.03). Regarding baseline serum Mg2+ and tidal volume, the cutoff point for predicting PW was less than or equal to 1.5 mg/dl and less than or equal to 6.3 ml/kg body weight, respectively, with sensitivity of 61.5 and 77%, respectively, specificity of 92.5 and 55%, respectively, positive predictive value of 72.7 and 36%, respectively, negative predictive value of 88.1 and 88%, respectively, accuracy of 77 and 66%, respectively, and P values of less than 0.0001 and less than 0.02, respectively. The cutoff points of PaCO2 of at least 49 mmHg and SaO2% of less than or equal to 91 at beginning of the first weaning trial and SaO2% change of at least 5 (between baseline and first weaning trial) were strongly associated with PW (P˂0.02, ˂0.0001, and ˂0.003, respectively). PW was significantly associated with mortality (P<0.0001).
Conclusion PW was associated with multiple factors; when subjected to multivariate analysis, only serum Mg2+ and SaO2% change (between baseline and first weaning trial) significantly predict PW. Increased ICU stay and mortality were significantly associated with PW.
Clinical implications Prolonged MV is associated with higher frequency of tracheostomy, reintubation, longer ICU stay, and poor outcome. Detection and correction of PW associated factors may improve the outcome. |
| first_indexed | 2024-12-11T09:33:22Z |
| format | Article |
| id | doaj.art-b0da407520154584af1376d75260acf6 |
| institution | Directory Open Access Journal |
| issn | 0422-7638 2090-9950 |
| language | English |
| last_indexed | 2024-12-11T09:33:22Z |
| publishDate | 2019-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Egyptian Journal of Chest Disease and Tuberculosis |
| spelling | doaj.art-b0da407520154584af1376d75260acf62022-12-22T01:12:58ZengWolters Kluwer Medknow PublicationsEgyptian Journal of Chest Disease and Tuberculosis0422-76382090-99502019-01-0168452653510.4103/ejcdt.ejcdt_186_18Predictors of prolonged weaning among mechanically ventilated patients in respiratory intensive care unitHamdy A MohammadienMostafa I AliMona T HussienDoaa G HassaninBackground Weaning has been classified into simple, difficult, and prolonged. Objective The aim of this study was to assess predictors of prolonged weaning (PW) and survival in the respiratory ICU (RICU). Patients and methods Fifty-three patients admitted to RICU and requiring mechanical ventilation (MV) were included in the study. According to the classification of weaning, patients were categorized into simple [20 (37.7%)], difficult [20 (37.7%)], and PW [13 (24.5%)]. Factors associated with PW and outcomes were assessed. Results Multiple factors were associated with PW: decreased serum Ca2+ (P<0.0001), Mg2+(P<0.0001), and albumin (P=0.001); increased urea (P=0.001), aspartate aminotransferase (P=0.0005), and alanine aminotransferase (P=0.0001); increased PaCO2 (P=0.04); decreased SaO2% (P<0.0001) at beginning of the first weaning trial; at least 2 comorbidities (P=0.02); increased duration of MV (P<0.0001); and increased ICU stay (P<0.0001). There was no significant association between PW and modes of MV (P=0.2); moreover, alveolar–arterial gradient decreased in patients with PW but was not significant (P=0.57). By multivariate analysis, PW was associated with low serum Mg2+ (odds ratio: 0.03, 95% confidence interval: 0.003–0.24, P=0.001), and SaO2% change (between baseline and first weaning trial) (odds ratio: 0.68, 95% confidence interval: 0.54–1.04, P=0.03). Regarding baseline serum Mg2+ and tidal volume, the cutoff point for predicting PW was less than or equal to 1.5 mg/dl and less than or equal to 6.3 ml/kg body weight, respectively, with sensitivity of 61.5 and 77%, respectively, specificity of 92.5 and 55%, respectively, positive predictive value of 72.7 and 36%, respectively, negative predictive value of 88.1 and 88%, respectively, accuracy of 77 and 66%, respectively, and P values of less than 0.0001 and less than 0.02, respectively. The cutoff points of PaCO2 of at least 49 mmHg and SaO2% of less than or equal to 91 at beginning of the first weaning trial and SaO2% change of at least 5 (between baseline and first weaning trial) were strongly associated with PW (P˂0.02, ˂0.0001, and ˂0.003, respectively). PW was significantly associated with mortality (P<0.0001). Conclusion PW was associated with multiple factors; when subjected to multivariate analysis, only serum Mg2+ and SaO2% change (between baseline and first weaning trial) significantly predict PW. Increased ICU stay and mortality were significantly associated with PW. Clinical implications Prolonged MV is associated with higher frequency of tracheostomy, reintubation, longer ICU stay, and poor outcome. Detection and correction of PW associated factors may improve the outcome.http://www.ejcdt.eg.net/article.asp?issn=0422-7638;year=2019;volume=68;issue=4;spage=526;epage=535;aulast=Mohammadienintensive care unitmechanical ventilationprolonged weaningrespiratory intensive care unitweaning |
| spellingShingle | Hamdy A Mohammadien Mostafa I Ali Mona T Hussien Doaa G Hassanin Predictors of prolonged weaning among mechanically ventilated patients in respiratory intensive care unit Egyptian Journal of Chest Disease and Tuberculosis intensive care unit mechanical ventilation prolonged weaning respiratory intensive care unit weaning |
| title | Predictors of prolonged weaning among mechanically ventilated patients in respiratory intensive care unit |
| title_full | Predictors of prolonged weaning among mechanically ventilated patients in respiratory intensive care unit |
| title_fullStr | Predictors of prolonged weaning among mechanically ventilated patients in respiratory intensive care unit |
| title_full_unstemmed | Predictors of prolonged weaning among mechanically ventilated patients in respiratory intensive care unit |
| title_short | Predictors of prolonged weaning among mechanically ventilated patients in respiratory intensive care unit |
| title_sort | predictors of prolonged weaning among mechanically ventilated patients in respiratory intensive care unit |
| topic | intensive care unit mechanical ventilation prolonged weaning respiratory intensive care unit weaning |
| url | http://www.ejcdt.eg.net/article.asp?issn=0422-7638;year=2019;volume=68;issue=4;spage=526;epage=535;aulast=Mohammadien |
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