Predictors of Outcomes in Patients with Prolonged Weaning with Focus on Respiratory Tract Pathogens and Infection

Abstract

Background: The impact of respiratory tract pathogens and infection on outcomes in patients with prolonged weaning is largely unknown. Objective: We studied predictors of weaning outcomes (death and failure to achieve spontaneous ventilation) in a population treated during a 3.5-year period in a specialized and certified weaning centre. Methods: Patient data were retrieved retrospectively from the clinical charts. Complete datasets were available in 173 patients. The following parameters were investigated as potential predictors of both endpoints: age; comorbidities; tracheobronchial pathogens; bacteraemia, pneumonia and number of pneumonias; and number of inhouse treatment cycles (none vs. ≥1). Results: Tracheobronchial pathogens, pneumonia, bacteraemia and the number of antibiotic cycles all significantly increased weaning duration and hospitalisation times. Independent predictors of death were atrial fibrillation (OR 2.6, 95% CI 1.2–5.8, p = 0.02) and tracheobronchial multiresistant Pseudomonas aeruginosa (OR 3.9, 95% CI 1.4–11.0, p = 0.01). Independent predictors of failure to achieve spontaneous ventilation included chronic obstructive pulmonary disease (OR 2.8, 95% CI 1.0–7.8, p = 0.045); neuromuscular disease (OR 8.3, 95% CI 1.2–27.2, p = 0.02); tracheobronchial P. aeruginosa (OR 3.3, 95% CI 1.3–9.3, p = 0.01); Stenotrophomonas maltophilia (OR 7.9, 95% CI 1.4–51.6, p = 0.02); and pneumonia (OR 4.4, 95% CI 1.5–10.9, p = 0.003). Conclusions: The impact of respiratory tract pathogens and infection on weaning outcomes was remarkable. Predictors of death and failure to achieve spontaneous ventilation differed considerably. A priority may be to investigate preventive strategies against colonisation and infection with respiratory pathogens, particularly P. aeruginosa.