Abstract
IntroductionThe effect of hemoglobin levels on the weaning outcomes of mechanically ventilated patients remains under debate, particularly for the patients with difficult weaning. This study aims to evaluate the effect of hemoglobin levels on weaning outcomes in difficult-to-wean patients.MethodsThis retrospective cohort study was conducted in a university-affiliated teaching hospital in Taiwan. Patients who fulfilled the criteria of difficult weaning were enrolled. Medical records were reviewed to obtain data on hemograms, biochemistry tests, transfusion records, comorbidities and weaning outcome. The association between hemoglobin levels and 30-day weaning outcomes was evaluated using a logistic regression model.ResultsA total of 751 patients received mechanical ventilation during the study period, 138 of whom fulfilled the criteria of difficult weaning. Compared with the patients whose hemoglobin was <8 g/dL, those with higher hemoglobin levels were more likely to be successfully weaned (odds ratio [OR], 3.69; 95% CI, 1.22–11.15 for hemoglobin 8–10 g/dL and OR, 4.16, 95% CI, 1.30–13.29 for hemoglobin >10 g/dL). Multivariate analysis showed that the odds ratio for weaning success remained significant for hemoglobin levels of 8–10 g/dL (adjusted OR, 3.3; 95% CI, 1.07–10.15) with borderline significance for hemoglobin level > 10 g/dL (adjusted OR, 2.95, 95% CI, 0.88–9.96).ConclusionsHemoglobin level is independently associated with weaning outcome in difficult-to-wean patients. Further studies are needed to evaluate whether a restrictive transfusion trigger for acute critical illness is also appropriate for such patients.
Highlights
The effect of hemoglobin levels on the weaning outcomes of mechanically ventilated patients remains under debate, for the patients with difficult weaning
We used the definition of difficult weaning as the inclusion criteria in this study: (1) patients who failed spontaneous breathing trials (SBT) two or more times; or (2) patients who required as many as 7 days from the first SBT to successful weaning
A total of 751 patients receiving invasive mechanical ventilation for more than 24 hours were screened for eligibility
Summary
The effect of hemoglobin levels on the weaning outcomes of mechanically ventilated patients remains under debate, for the patients with difficult weaning. This study aims to evaluate the effect of hemoglobin levels on weaning outcomes in difficult-to-wean patients. Further studies are needed to evaluate whether a restrictive transfusion trigger for acute critical illness is appropriate for such patients. A transfusion trigger is a tolerable threshold of anemia compromised by the adverse effects from transfusion but is not a truly appropriate hemoglobin level for that patient. The impact of hemoglobin levels on the outcome of a specific patient group should be studied beyond the scope of a transfusion trigger because the risk of transfusion-related adverse effects is partly preventable [8,9]
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