Weaning success may extend survival in prolonged ventilation patients

Key takeaways:

• The risk for mortality at 1 year and 3 years did not significantly differ among successfully vs. unsuccessfully weaned patients.
• The nonsignificant lower risk with successful weaning needs to be studied further.

Adults receiving prolonged mechanical ventilation may benefit in terms of survival with successful weaning, according to results published in Respiratory Medicine.

“Our results indicate a possible survival advantage for patients successfully weaned from prolonged mechanical ventilation (PMV),” Mila Fradkin, MPH, of the department of epidemiology and preventive medicine at Tel Aviv University, and colleagues wrote. “Successfully weaned PMV patients may benefit by becoming independent on a ventilator but also by having a better long-term prognosis than unweaned PMV patients.”

In a historical cohort study, Fradkin and colleagues analyzed 223 adults (mean age, 67 years; 39% women) who experienced prolonged mechanical ventilation in a rehabilitation hospital to find out what characteristics positively impact weaning and the impact of successful vs. unsuccessful weaning on 3-year survival.

Within the total cohort, a slightly larger proportion of patients underwent weaning attempts compared with the proportion who did not have any attempts (n = 124 vs. n = 99).

Further, successful weaning occurred more often than unsuccessful weaning (55.6% vs. 44.4%).

Researchers observed no significant differences in age, sex, comorbidity distribution, albumin levels and the proportion of conscious patients based on the success or failure of weaning.

In contrast, the difference between the successful and unsuccessful weaning groups was borderline significant when considering receipt of 5-day or longer antibiotic treatment (74% vs. 80%; P = .07).

In terms of time, fewer patients who successfully vs. unsuccessfully weaned had to wait longer than 14 days from intubation to tracheostomy (44.9% vs. 65.5%; P = .02). Patients with a successful weaning attempt had a shorter median number of days between these two events than patients with an unsuccessful attempt (13 vs. 19 days; P = .01).

Researchers found the opposite when evaluating the median number of days from intubation to first weaning attempt, with a lower median in the unsuccessful group (66 days vs. 94 days; P = .005).

A nonsignificant, comparable proportion of patients survived in the successfully weaned group and the unsuccessfully weaned group at 1 year (78% vs. 69%) and 3 years (56% vs. 47%), according to researchers.

Researchers further found a nonsignificant relationship between successful weaning and reduced 1-year mortality risk (adjusted HR = 0.75; 95% CI, 0.33-1.6), as well as 3-year mortality risk (aHR = 0.77; 95% CI, 0.42-1.39) when compared with unsuccessful weaning in a model adjusted for age, sex, antibiotic treatment, time to tracheostomy over 14 days and admission time to first weaning attempt.

“More studies are warranted to examine other patient-related health outcomes in patients who have undergone weaning from extended mechanical ventilation,” Fradkin and colleagues wrote.