Acute Crit Care.  2020 Aug;35(3):156-163. 10.4266/acc.2020.00199.

Clinical outcomes of difficult-to-wean patients with ventilator dependency at intensive care unit discharge

• Lee JM
• Lee SM
• Song JH
• Kim YS

• KMID: 2506094
• DOI: http://doi.org/10.4266/acc.2020.00199

Abstract

Background
Ventilator-dependent patients in the intensive care unit (ICU) who are difficult to wean from invasive mechanical ventilation (IMV) have been increasing in number. However, data on the clinical outcomes of difficult-to-wean patients are lacking. We aimed to evaluate clinical outcomes in patients discharged from the ICU with tracheostomy and ventilator dependency.
Methods
We retrospectively investigated clinical course and survival in patients requiring home mechanical ventilation (HMV) with a tracheostomy and difficulty weaning from IMV during medical ICU admission from September 2013 through August 2016 at Severance Hospital, Yonsei University, Seoul, Korea.
Results
Of 84 difficult-to-wean patients who were started on HMV in the medical ICU, 72 survived, were discharged from the ICU, and were included in this analysis. HMV was initiated after a median of 23 days of IMV, and the successful weaning rate was 46% (n = 33). In-hospital mortality rate was significantly lower in the successfully weaned group than the unsuccessfully weaned group (0% vs. 23.1%, respectively; P = 0.010). Weaning rates were similar according to primary diagnosis, but high body mass index (BMI), low Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score at ICU admission, and absence of neuromuscular disease were associated with weaning success. After a median follow-up of 4.6 months (range, 1–27 months) for survivors, 3-month (n = 64) and 6-month (n = 59) survival rates were 82.5% and 72.2%, respectively. Survival rates were higher in the successfully weaned group than the unsuccessfully weaned group at 3 months (96.4% vs. 69.0%; P = 0.017) and 6 months (84.0% vs. 62.1%; P = 0.136) following ICU discharge.
Conclusions
In summary, 46% of patients who started HMV were successfully weaned from the ventilator in general wards. High BMI, low APACHE II score, and absence of neuromuscular disease were factors associated with weaning success.

Keyword

intensive care unit; mechanical ventilators; ventilator weaning

Figure

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  Figure 1. Flowchart of patient enrollment. HMV: home mechanical ventilation; ICU: intensive care unit.

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  Figure 2. Flow diagram of patient outcomes with home mechanical ventilation (HMV). ICU: intensive care unit.

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