Assessment of Weaning from Mechanical Ventilation in Critically Ill Patients at Thammasat University Hospital

Abstract

Separation from mechanical ventilation (MV) is a crucial process and a key challenge for intensive care unit (ICU) clinicians. Weaning methods vary widely in clinical practices. This study aimed to describe the clinical characteristics and outcomes of patients weaning from invasive MV in ICU settings. We conducted a prospective observational study in patients requiring MV with endotracheal intubation for at least 48 hours in a medical ICU. Patient and weaning characteristics, ICU length of stay, ICU mortality, and 90-day hospital mortality were recorded. Thirty-two patients (50% male) were included. Mean±SD age was 59.4±18.6 years. The sequential organ failure assessment (SOFA) scores were 10.7±4.3. The Acute Physiology and Chronic Health Evaluation (APACHE) II scores were 23.5±9.5. Hypoxemic respiratory failure (84.4%) was the most common indication for MV. Duration from initial weaning to successful separation from MV was 3.5±1.9 days. Weaning success within 14 days after ICU admission was 53.1%. ICU length of stay was 8.4±7.4 days. ICU mortality and 90-day hospital mortality rates were 31. 3 % and 34. 4%, respectively. There was no weaning of deceased patients. Compared to deceased patients, survivors had lower SOFA and APACHE II scores, peak airway pressure, respiratory rate, and positive end-expiratory pressure during MV use, but higher pH. The survived group had a higher proportion of effective cough than the deceased group. In conclusion, survived ICU patients had more effective cough. Deceased patients had higher ICU severity scores and worse respiratory parameters. These results suggest that ICU patients with severe illness who have ineffective cough need to be closely monitored and need to receive more interventions to improve clinical outcomes.