Predictors of weaning success from prolonged mechanical ventilation: A protocol study

Objectives To describe the outcomes of a large cohort of patients who have been on ventilation for > 14 days (extended prolonged ventilation) and identify unique predictors of weaning success within this group. We also aimed to examine the impact of diuretic therapy before weaning on the likelihood of successful weaning. Design: A retrospective study. Setting: The computerized database of Soroka University Medical Center, a tertiary 1191-bed medical center serving a population of 1.2 million residents. Participants: Overall, 88 patients were included in our study cohort. Forty patients (45%) were successfully weaned off mechanical ventilation and subsequently discharged either to rehabilitation facilities or directly to their homes. Main outcome measures: We analyzed the weaning success rate from extended prolonged mechanical ventilation and explored potential predictors for success using multivariate logistic regression. Results The in-hospital mortality rate was 28% (25 patients). All-cause mortality within 1 month and 1 year of discharge was 11% (10 patients) and 28% (20 patients), respectively. Hypoalbuminemia was the only significant predictor of weaning failure, with an odds ratio of 7.27. However, demographic factors such as age, comorbidities, reasons for mechanical ventilation, clinical and laboratory data at the time of admission, and diuretics treatment a few days before the initiation of weaning were not significant predictors of weaning success. Conclusions As patients stabilize and recover from the acute phase of illness that necessitates mechanical ventilation, rapid weaning success predictors may become less relevant in patients on long-term ventilation. Hypoalbuminemia has multiple potential mechanisms that may cause weaning failure in cases of prolonged ventilation. Therefore, interventions aimed at correcting hypoalbuminemia by improving the metabolic state may potentially enhance weaning success rates.