Maximal expiratory pressure is associated with reinstitution of mechanical ventilation after successful unassisted breathing trials in tracheostomized patients with prolonged mechanical ventilation
Journal
PLoS ONE
Journal Volume
15
Journal Issue
3
Pages
e0229935
Date Issued
2020
Author(s)
Abstract
Objective Reinstitution of mechanical ventilation (MV) for tracheostomized patients after successful weaning may occur as the care setting changes from critical care to general care. We aimed to investigate the occurrence, consequence and associated factors of MV reinstitution. Methods We analyzed the clinical data and physiological measurements of tracheostomized patients with prolonged MV discharged from the weaning unit to general wards after successful weaning to compare between those with and without in-hospital MV reinstitution within 60 days. Results Of 454 patients successfully weaned, 116 (25.6%) reinstituted MV at general wards within 60 days; at hospital discharge, 42 (36.2%) of them were eventually liberated from MV, 51 (44.0%) remained MV dependent, and 33 (28.4%) died. Of the 338 patients without reinstitution within 60 days, only 3 (0.9%) were later reinstituted with MV before discharge (on day 67, 89 and 136 at general wards, respectively), and 322 (95.2%) were successfully weaned again at discharge, while 13 (3.8%) died. Patients with MV reinstitution had a significantly lower level of maximal expiratory pressure (PEmax) before unassisted breathing trial compared to those without reinstitution. Multivariable Cox regression analysis showed fever at RCC discharge (hazard ratio [HR] 14.00, 95% confidence interval [CI] 3.2–61.9) chronic obstructive pulmonary disease (HR 2.37, 95% CI 1.34–4.18), renal replacement therapy at the ICU (HR 2.29, 95% CI 1.50–3.49) and extubation failure before tracheostomy (HR 1.76, 95% CI 1.18–2.63) were associated with increased risks of reinstitution, while PEmax > 30 cmH2O (HR 0.51, 95% CI 0.35–0.76) was associated with a decreased risk of reinstitution. Conclusions The reinstitution of MV at the general ward is significant, with poor outcomes. The PEmax measured before unassisted breathing trial was significantly associated with the risk of reinstituting MV at the general wards. ? 2020 Lin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
adult; aged; Article; artificial ventilation; chronic obstructive lung disease; confidence interval; extubation; female; fever; hazard ratio; hospital discharge; human; intensive care unit; major clinical study; male; maximal expiratory pressure; proportional hazards model; renal replacement therapy; retrospective study; tracheostomy; ventilator weaning; very elderly; adverse event; clinical decision making; clinical protocol; health care facility; intensive care; maximal respiratory pressure; middle aged; predictive value; prognosis; respiratory failure; retreatment; time factor; treatment outcome; Aged; Aged, 80 and over; Clinical Decision-Making; Clinical Protocols; Critical Care; Female; Humans; Intensive Care Units; Male; Maximal Respiratory Pressures; Middle Aged; Patients' Rooms; Predictive Value of Tests; Prognosis; Respiratory Insufficiency; Retreatment; Retrospective Studies; Time Factors; Tracheostomy; Treatment Outcome; Ventilator Weaning
Publisher
Public Library of Science
Type
journal article