Weaning critically ill patients from mechanical ventilation: A prospective cohort study

Pu, Lin; Zhu, Bo; Jiang, Li; Du, Bin; Zhu, Xi; Li, Ang; Li, Gang; He, Zhonghu; Chen, Wei; Ma, Pan; Jia, Jianguo; Xu, Yuan; Zhou, Jianxin; Qin, Long; Zhan, Qimin; Li, Wenxiong; Jiang, Qi; Wang, Meiping; Lou, Ran; Xi, XiuMing

doi:10.1016/j.jcrc.2015.04.001

Cited by 36 publications

(33 citation statements)

References 37 publications

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“…However, the long-term use of IMV may result in hazardous complications, such as ventilator-associated pneumonia, barotrauma, oxygen toxicity, and increased use of sedatives and cost [4,5]. Furthermore, it has been reported that prolonged weaning was associated with higher hospital mortality [6]. Therefore, early identification of pneumonia patients with risk of extubation failure is of great clinical significance because interventions might be planned and implemented when risk could be predicted and monitored.…”

Section: Introductionmentioning

confidence: 99%

Early prediction of extubation failure in patients with severe pneumonia: a retrospective cohort study

Luo

et al. 2020

Bioscience Reports

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Backgroud: Severe pneumonia is one of the most common causes for mechanical ventilation. We aimed to early identify severe pneumonia patients with high risk of extubation failure in order to improve prognosis. Methods: From April 2014 to December 2015, medical records of intubated patients with severe pneumonia in intensive care unit were retrieved from database. Patients were divided into extubation success and failure groups, and multivariate logistic regressions were performed to identify independent predictors for extubation failure. Results: A total of 125 eligible patients were included, of which 82 and 43 patients had extubation success and failure, respectively. APACHE II score (odds ratio (OR) 1.141, 95% confident interval (CI) 1.022–1.273, P = 0.019, cutoff at 17.5), blood glucose (OR 1.122, 95%CI 1.008–1.249, P = 0.035, cutoff at 9.87 mmol/l), dose of fentanyl (OR 3.010, 95%CI 1.100–8.237, P = 0.032, cutoff at 1.135 mg/d), and the need for red blood cell (RBC) transfusion (OR 2.774, 95%CI 1.062–7.252, P = 0.037) were independent risk factors for extubation failure. Conclusion: In patients with severe pneumonia, APACHE II score > 17.5, blood glucose > 9.87 mmol/l, fentanyl usage > 1.135 mg/d, and the need for RBC transfusion might be associated with higher risk of extubation failure.

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Section: Introductionmentioning

confidence: 99%

Early prediction of extubation failure in patients with severe pneumonia: a retrospective cohort study

Luo

et al. 2020

Bioscience Reports

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“…However, ICC classification had some problems when applied in clinical practice: (a) it does not apply to patients without a weaning trial (unplanned extubation, death, or transfer out), (b) patients with tracheostomy tube before weaning trials are difficult to classify with ICC, and (c) ICC classification is based only on the successful results of SBT. Therefore, approximately half of mechanically ventilated patients could not be classified by the ICC classification [ 3 , 4 , 6 , 7 ]. To overcome these limitations, the WIND (Weaning according to a New Definition) Study Group and the REVA (Réseau Européen de Recherche en Ventilation Artificielle) Network proposed a new classification using four different groups (Groups 1, 2, 3, and no weaning [NW]) [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Validation of a new WIND classification compared to ICC classification for weaning outcome

Jeong

Lee

Nam

et al. 2018

Ann. Intensive Care

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BackgroundAlthough the WIND (Weaning according to a New Definition) classification based on duration of ventilation after the first separation attempt has been proposed, this new classification has not been tested in clinical practice. The objective of this cohort study was to evaluate the clinical relevance of WIND classification and its association with hospital mortality compared to the International Consensus Conference (ICC) classification.MethodsAll consecutive medical ICU patients who were mechanically ventilated for more than 24 h between July 2010 and September 2013 were prospectively registered. Patients were classified into simple, difficult, or prolonged weaning group according to ICC classification and Groups 1, 2, 3, or no weaning (NW) according to WIND classification.ResultsDuring the study period, a total of 1600 patients were eligible. These patients were classified by the WIND classification as follows: Group NW = 580 (36.3%), Group 1 = 617 (38.6%), Group 2 = 186 (11.6%), and Group 3 = 217 (13.6%). However, only 735 (45.9%) patients were classified by ICC classification as follows: simple weaning = 503 (68.4%), difficult weaning = 145 (19.7%), and prolonged weaning = 87 (11.8%). Clinical outcomes were significantly different across weaning groups by ICC classification and WIND classification. However, there were no statistical differences in successful weaning rate (96.6% vs. 95.2%) or hospital mortality (22.5% vs. 25.5%) between simple and difficult weaning groups by the ICC. Conversely, there were statistically significant differences in successful weaning rate (98.5% vs. 76.9%) and hospital mortality (21.2% vs. 33.9%) between Group 1 and Group 2 by WIND.ConclusionsThe WIND classification could be a better tool for predicting weaning outcomes than the ICC classification.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0461-z) contains supplementary material, which is available to authorized users.

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“…The prevalence of reintubation within 48 -72 h after planned extubation is 9 -17% (average value of 13%). [4][5][6][7] In addition, re-intubation is associated with an 8-fold increase in nosocomial pneumonia and a 3-fold increase in hospital death. 8 Thus, it is very important to decrease re-intubation.…”

Section: Introductionmentioning

confidence: 99%

Use of Cough Peak Flow Measured by a Ventilator to Predict Re-Intubation When a Spirometer Is Unavailable

Bai¹,

Duan²

2017

Respir Care

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Weaning critically ill patients from mechanical ventilation: A prospective cohort study

Cited by 36 publications

References 37 publications

Early prediction of extubation failure in patients with severe pneumonia: a retrospective cohort study

Early prediction of extubation failure in patients with severe pneumonia: a retrospective cohort study

Validation of a new WIND classification compared to ICC classification for weaning outcome

Use of Cough Peak Flow Measured by a Ventilator to Predict Re-Intubation When a Spirometer Is Unavailable

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