Author/Authors :
Lee, Jung Mo Department of Internal Medicine - National Health Insurance Service Ilsan Hospital - Goyang, Korea , Lee, Sun-Min Department of Internal Medicine - National Health Insurance Service Ilsan Hospital - Goyang, Korea , Song, Joo Han Department of Internal Medicine - Institute of Chest Diseases - Severance Hospital - Yonsei University College of Medicine - Seoul, Korea , Kim, Young Sam Department of Internal Medicine - Institute of Chest Diseases - Severance Hospital - Yonsei University College of Medicine - Seoul, Korea
Abstract :
Background: Ventilator-dependent patients in the intensive care unit (ICU) who are difficult
to wean from invasive mechanical ventilation (IMV) have been increasing in number. However, data on the clinical outcomes of difficult-to-wean patients are lacking. We aimed to evaluate clinical outcomes in patients discharged from the ICU with tracheostomy and ventilator
dependency.
Methods: We retrospectively investigated clinical course and survival in patients requiring
home mechanical ventilation (HMV) with a tracheostomy and difficulty weaning from IMV
during medical ICU admission from September 2013 through August 2016 at Severance Hospital, Yonsei University, Seoul, Korea.
Results: Of 84 difficult-to-wean patients who were started on HMV in the medical ICU, 72
survived, were discharged from the ICU, and were included in this analysis. HMV was initiated
after a median of 23 days of IMV, and the successful weaning rate was 46% (n=33). In-hospital mortality rate was significantly lower in the successfully weaned group than the unsuccessfully weaned group (0% vs. 23.1%, respectively; P=0.010). Weaning rates were similar
according to primary diagnosis, but high body mass index (BMI), low Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score at ICU admission, and absence of
neuromuscular disease were associated with weaning success. After a median follow-up of 4.6
months (range, 1–27 months) for survivors, 3-month (n=64) and 6-month (n=59) survival
rates were 82.5% and 72.2%, respectively. Survival rates were higher in the successfully weaned
group than the unsuccessfully weaned group at 3 months (96.4% vs. 69.0%; P=0.017) and 6
months (84.0% vs. 62.1%; P=0.136) following ICU discharge.
Conclusions: In summary, 46% of patients who started HMV were successfully weaned from
the ventilator in general wards. High BMI, low APACHE II score, and absence of neuromuscular disease were factors associated with weaning success.