Warnke et al identified predictors of survival for a patient having prolonged weaning from mechanical ventilation. These can help to identify a patient who may require more aggressive management. The authors are from University Hospital Greifswald in Germany.
Patient selection: prolonged weaning from mechanical ventilation
Successful weaning was defined as spontaneous breathing for >= 72 hours without signs of exhaustion. The group included patients who are completely weaned or patients receiving noninvasive ventilation.
Prolonged weaning - one or both of the following:
(1) invasive ventilation for > 7 days after first attempt of extubation
(2) failure of diverse attempts of extubation
Predictors of worse survival post-discharge by multivariate analysis:
(1) age in years (HR 1.03)
(2) fever (HR 0.7)
(3) number of days on the ventilator (HR 1.01; median 66 for invasive mechanical ventilation; 42 for noninvasive ventilation; completely weaned 26)
(4) invasive mechanical ventilation at discharge (HR 1.42)
(5) cluster 2 (HR 2.4: critical illness polyneuropathy, pneumonia, delirium)
(6) cluster 4 (HR 1.5: neuromuscular disease; interstitial lung disease, pulmonary hypertension, restrictive thoracic disorder)
(7) discharge with open tracheostomy
