Successful Weaning Predictors in a Respiratory Care Center in Taiwan

Abstract

Respiratory care centers (RCCs) provide effective care for patients who have been in intensive care and have undergone prolonged mechanical ventilation. Between February 2002 and December 2005, 891 patients who met the admission criteria of RCCs were referred to our RCC at Kaohsiung Medical University Hospital in southern Taiwan for attempted weaning. We recorded demographic and clinical data, including variables identified previously as predictive of weaning success among highly selected populations. The common causes of respiratory failure at RCC admission were neuromuscular disease (29.2%), pneumonia (27.5%), cancer (18.0%), cardiovascular disease (10.1%), sepsis (5.7%) and post-surgery (1.6%). The percentage of patients successfully weaned was 40.2%, while 59.8% remained dependent on ventilators. In a stepwise multivariate logistic regression analysis, significant predictors of weaning success included neuromuscular disease (odds ratio [OR], 2.64), APACHE II score (OR, 0.93) and blood urea nitrogen level at RCC admission (OR, 0.99). The results could be helpful in the accreditation of medical care quality and may provide guidelines for future research and education programs.

Tracheostomy versus Endotracheal Intubation Prior to Admission to a Respiratory Care Center: A Retrospective Analysis

“…In addition, failed weaning, higher APACHE II score, higher BUN, and lower albumin also contributed to hospital mortality. These finding are supported by previously reported studies 5,12,16,21,24,25 . Higher serum albumin level has been demonstrated to be a proxy indicator of better nutrition status, and higher weaning success in PMV patients 12,24,25 .…”

“…These finding are supported by previously reported studies 5,12,16,21,24,25 . Higher serum albumin level has been demonstrated to be a proxy indicator of better nutrition status, and higher weaning success in PMV patients 12,24,25 . In general, the risk for weaning failure is greatest for medical patients, with the possible correlation of various comorbidities in these patients 5 .…”

“…Moreover, elevated BUN levels may be indicative of impaired renal function, the possibility of multiple comorbidities, metabolic dysfunction, and higher risk of subsequent chronic kidney disease development, all of which are consistent with weaning failure and poor outcomes in a post-ICU setting 12,16,25 . Furthermore, the APACHE II scoring system was originally designed to assess the severity of a disease/relative morbidity in ICU, hence providing a guide for treatment intervention and a predictor of weaning success 5,12,24 . Specifically, we found that patients with lower BUN levels (indicating adequate metabolic functioning), higher albumin concentrations (indicating adequate nutritional status), and lower APACHE II scores (indicating the severity of disease) were significantly more likely to be successfully weaned from mechanical ventilation and survive, as reported in the literature 12 .…”

Characteristics and Outcome for Very Elderly Patients (≥ 80 years) Admitted to a Respiratory Care Center in Taiwan

“…In studies by Su et al and Wu et al, there was a trend for difficult weaning in elderly patients in Taiwan 3,17 . In addition, Yang et al found that age was a predictor for weaning in the RCC 18 . However, their patients were younger than in our study and that by Wu et al, which might explain the difference.…”

Successful Mechanical Ventilation Weaning Experiences at Respiratory Care Centers

“…This may be because in respiratory care centers mechanical ventilation is used for at least 21 days. Some studies have indicated that the average number of days on mechanical ventilation exceeds 40 days in respiratory care centers, and the difficulties of weaning such individuals on long-term ventilator support are significantly increased (Henneman, Dracup, Ganz, Molayeme, & Cooper, 2002;O'Bryan, Von Rueden, & Malila, 2002;Yang et al, 2008).…”