Predictors of Weaning After 6 Weeks of Mechanical Ventilation

Abstract

To identify variables associated with weaning outcome in long-term ventilator-dependent patients. Using those variables, to construct models to predict weaning success and to test the accuracy of those models. Retrospective medical record review. Regional weaning center (RWC). An initial group of 421 and a subsequent group of 170 consecutive patients referred for attempted weaning after 6 weeks of mechanical ventilation. Data obtained on admission to our facility were analyzed for correlation with weaning outcome. In the initial patient group, selected variables which correlated with weaning success were alveolar-arterial oxygen pressure difference (P[A-a]O2), BUN, BUN/creatinine ratio (each with p < or = 0.001), and female gender (p = 0.04). We used these variables in logistic regression models to predict weaning success in this population. We then tested the models in the 170-patient validation group using both standard and receiver operating characteristic (ROC) curve analysis. The ROC analysis indicated 59% accuracy using P(A-a)O2 alone and 68% accuracy using all previously mentioned variables. We used data from all 565 patients with known outcome and omitted BUN/creatinine ratio to fashion a simple scoring system to predict weaning success with 70% accuracy using P(A-a)O2, BUN, and Gender--the A+B+G score. In patients suffering prolonged mechanical ventilation, models incorporating simple measurements allowed construction of a score to predict weaning success at our RWC.