Maximal expiratory pressure is associated with reinstitution of mechanical ventilation after successful unassisted breathing trials in tracheostomized patients with prolonged mechanical ventilation

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 (P E max) 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 P E max > 30 cmH 2 O (HR 0.51, 95% CI 0.35-0.76) was associated with a decreased risk of reinstitution.

Kinetics of oxygen uptake during unassisted breathing trials in prolonged mechanical ventilation: a prospective pilot study

“…Furthermore, it may be easier to make the decision to continue ongoing unassisted breathing in situations where the patient is showing subjective distress without clinical failure. Bridging measures to step down to unassisted breathing using a slower weaning process 37 , such as applying external continuous positive airway pressure to recruit the atelectatic area, and to remove airway secretions or accumulating pleural effusion, may also be provided earlier when the monitoring suggests a trend of increasing O 2 .…”

Application of respiratory function tests in patients with neurological diseases

“…MEP, MIP, and rapid shallow breathing index calculated as the tidal volume divided by the respiratory rate of higher than 30 cmH 2 O, higher than 36 cmH 2 O, and lower than 105 breaths/min/L, respectively, probably indicate successful weaning. [75][76][77] The characteristics and clinical applications of respiratory function tests are summarized in Table 1.…”