Reinstitution of Mechanical Ventilation within 14 Days as a Poor Predictor in Prolonged Mechanical Ventilation Patients following Successful Weaning

Mei-Lien Tu,Ching-Wan Tseng,Wen-Feng Fang,Yung-Che Chen,Chin-Chou Wang,Meng-Chih Lin,Shih-Feng Liu,Chia-Cheng Tseng,Yuh Chyn Tsai

doi:10.1100/2012/957126

Mei-Lien Tu, Ching-Wan Tseng + Show 7 more

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https://doi.org/10.1100/2012/957126

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Abstract

Although many parameters were investigated about weaning and mortality in critical patients in intensive units, no studies have yet investigated predictors in prolonged mechanical ventilation (PMV) patients following successful weaning. A cohort of 142 consecutive PMV patients with successful weaning in our respiratory care center was enrolled in this study. Successful weaning is defined as a patient having smooth respiration for more than 5 days after weaning. The results showed as follows: twenty-seven patients (19%) had the reinstitution within 14 days, and 115 patients (81%) had the reinstitution beyond 14 days. Renal disease RIFLE-LE was associated with the reinstitution within 14 days (P = 0.006). One year mortality rates showed significant difference between the two groups (85.2% in the reinstitution within 14 days group versus 53.1% in the reinstitution beyond 14 days; P < 0.001). Kaplan-Meier analysis showed that age ≥70 years (P = 0.04), ESRD (P = 0.02), and the reinstitution within 14 days (P < 0.001) were associated with one-year mortality. Cox proportional hazards regression model showed that only the reinstitution within 14 days was the independent predictor for mortality (P < 0.001). In conclusion, the reinstitution within 14 days was a poor predictor for PMV patients after successful weaning.

Highlights

In recent years, advanced intensive care has prolonged survival rates in patients with severe illness than the past
The reinstitution within 14 days was a poor predictor for prolonged mechanical ventilation (PMV) patients after successful weaning
The setting was from respiratory care center (RCC) in Kaohsiung Chang Gung Memorial Hospital, a 2300-bed facility serving as a primary care and tertiary referral center in Taiwan, between November 2004 and June 2005, consecutive 142 PMV patients who were weaned successfully from ventilators in the RCC were recruited into this study

Summary

Introduction

In recent years, advanced intensive care has prolonged survival rates in patients with severe illness than the past. Without facilities for postintensive care, these patients would require extended stays in intensive care units (ICUs). The cost of such patients on prolonged mechanical ventilation (PMV) could account for approximately 5–20% of the total budget and resources earmarked for intensive care by the Taiwan Central Government. To increase the availability of ICU beds for acute illness patients and to improve successful weaning rates for chronic respiratory failure patients, the National Health Insurance Bureau of Taiwan developed the integrated delivery system (IDS) in 1990. Most PMV patients with exceeding 21 days were sent to respiratory care center (RCC) for further management

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