Analysis of risk factors for weaning failure from mechanical ventilation in critically ill older patients with coronavirus disease 2019

Abstract

ObjectiveThis study aimed to investigate the factors influencing weaning failure from invasive mechanical ventilation (IMV) in critically ill older patients with coronavirus disease 2019 (COVID-19). MethodsWe enrolled critically ill older patients with COVID-19 who were admitted to the medical intensive care unit (ICU) and received IMV between December 2022 and June 2023. ResultsWe included 68 critically ill older patients with COVID-19 (52 male [76.5 %] and 16 female individuals [23.5 %]). The patients’ median age (interquartile range) was 75.5 (70.3–82.8) years. The median length of ICU stay was 11.5 (7.0–17.8) days; 34 cases (50.0 %) were successfully weaned from IMV. The successfully weaned group had a higher proportion of underlying chronic obstructive pulmonary disease [6 (17.6 %) vs. 0, P = 0.033] and fewer cases of diabetes [7 (20.6 %) vs. 16 (47.1 %), P = 0.021] compared with the weaning failure group. Serum lactate levels [1.5 (1.2–2.3) vs. 2.6 (1.9–3.1) mmol/L, P < 0.001], blood urea nitrogen [8.2 (6.3–14.4) vs. 11.4 (8.0–21.3) mmol/L, P = 0.033], Acute Physiology and Chronic Health Evaluation (APACHE) II score [19.0 (12.0–23.3) vs. 22.5 (16.0–29.3), P = 0.014], and hospitalization days before endotracheal intubation [1.0 (0.0–5.0) vs. 3.0 (0.0–11.0), P = 0.023] were significantly decreased in the successfully weaned group, whereas PaO2/FiO2 [148.3 (94.6–200.3) vs. 101.1 (67.0–165.1), P = 0.038] and blood lymphocyte levels [0.6 (0.4–1.0) vs. 0.5 (0.2–0.6) 109/L, P = 0.048] were significantly increased, compared with the weaning failure group. Multivariate logistic regression analysis showed that diabetes (OR= 3.413, 95 %CI 1.029−11.326), P = 0.045), APACHE II Score (OR = 1.089, 95 % CI 1.008−1.175), P = 0.030), and hospitalization days before endotracheal intubation (OR = 1.137, 95 % CI 1.023−1.264), P = 0.017) were independent risk factors for weaning failure. ConclusionIn critically ill older patients with COVID-19 with diabetes, higher APACHE II Score, and longer hospitalization days before endotracheal intubation, weaning from IMV was more challenging. The study could help develop strategies for improving COVID-19 treatment.