Factors Affecting Mechanical Ventilator Weaning Success and 28-Day Survival Among Patients With Acute Respiratory Distress Syndrome Secondary to COVID-19.

Abstract

The process of weaning patients off mechanical ventilation (MV) is difficult and complex. Critical care nurses must maintain continuity of care for patients undergoing MV weaning, assess patients' overall condition, and meet patients' needs. The study aimed to explore clinical factors of MV weaning success and 28-day survival among patients with acute respiratory distress syndrome secondary to COVID-19. This prospective observational study was conducted on 90 newly admitted patients in the general intensive care unit Assiut Univeristy Main Hospital in Egypt from October 2021 to March 2022. The researchers applied a standard weaning protocol for all of the patients in this study and then assessed the outcome variables: success or failure of weaning trials from a mechanical ventilator, and 28-day survival. In total, 50 (55.6%) patients were successfully weaned from MV, and 45 (50%) patients survived at 28 days. In a multivariate regression analysis, dynamic compliance (OR, 1.115; 95% CI, 1.010-1.230, p = .031*), lymphocyte count (OR, 3.025; 95% CI, 1.322-6.923, p = .009*), urine output (OR, 1.002; 95% CI, 1.001-1.004, p = .002*), and alanine aminotransferase (ALT; OR, 0.993; 95% CI, 0.988-0.999, p = .017*) were significantly associated with weaning success. In addition, age (OR, 1.058; 95% CI, 1.015-1.102; p = .007*), lymphocyte count (OR, 3.304; 95% CI, 1.348-8.100; p = .009*), urine output (OR, 1.003; 95% CI, 1.001-1.004; p = .001*), and ALT (OR, 0.994; 95% CI, 0.989-0.99, p = .015*) were significantly associated with survival at 28 days. Dynamic lung compliance, lymphocyte count, urine output, and ALT were found to be predictive parameters that may affect the success of weaning off MV. Additionally, it was found that age, lymphocyte count, urine output, and ALT are predictors of survival at 28 days. We recommend further studies with larger, more systematic samples and complete follow-up, focusing on pulmonary function and quality of life in postweaning patients with acute respiratory distress syndrome.