Weaning chronically critically ill adults from mechanical ventilatory support: a descriptive study

BACKGROUND: Ventilator-dependent patients average 11,419 daily in US acute care hospitals. OBJECTIVE: To describe the process of ventilatory weaning among chronically critically ill adults. METHODS A retrospective survey was used to study ventilator-dependent adults enrolled in a larger randomized study. Patients records were used to obtain duration of mechanical ventilatory support, success of weaning, serum albumin level, left ventricular function, number of drugs used to treat heart failure, and 24-hour fluid balance. Data were collected on admission to the intensive care unit; 24 hours after initiation of mechanical ventilation; and 7 days before, and on the day of, weaning status determination. RESULTS: Of 174 subjects, 120 were weaned from mechanical ventilation. There were no differences in maximum inspiratory pressure, minute ventilation, or ventilatory capacity between successful and unsuccessful candidates. There were differences in serum albumin level, rapid shallow breathing index, fraction of inspired oxygen, and 24-hour fluid balance. Among subjects who were weaned, the duration of mechanical ventilation was significantly longer in those with left ventricular dysfunction (n = 53; 29.1 +/- 25.2 days) than in those with normal left ventricular function (n = 67; 21.1 +/- 18.1 days). Subjects who were weaned received a greater number of drugs to treat heart failure (1.46 +/- 1.24) than did those who were not (0.77 +/- 1.04). CONCLUSIONS Many weaning parameters do not differentiate patients able to be weaned from those who are unable. The presence of left ventricular dysfunction, number of drugs used to treat heart failure, serum albumin level, and 24-hour fluid balance were associated with weaning success and/or duration of mechanical ventilation in adults requiring prolonged mechanical ventilation.

This article has been cited by other articles:

				M. O'Shea Forbes Prolonged Ventilator Dependence: Perspective of the Chronic Obstructive Pulmonary Disease Patient Clin Nurs Res, August 1, 2007; 16(3): 231 - 250. [Abstract] [PDF]

				S. K. Frazier, K. S. Stone, D. Moser, R. Schlanger, C. Carle, L. Pender, J. Widener, and H. Brom Hemodynamic Changes During Discontinuation of Mechanical Ventilation in Medical Intensive Care Unit Patients Am. J. Crit. Care., November 1, 2006; 15(6): 580 - 593. [Abstract] [Full Text] [PDF]

				B. A. Delmore Levine's Framework in Long-Term Ventilated Patients During the Weaning Course. Nurs Sci Q, July 1, 2006; 19(3): 247 - 258. [Abstract] [PDF]

				P. A. Higgins, B. J. Daly, A. R. Lipson, and S.-E. Guo Assessing Nutritional Status in Chronically Critically Ill Adult Patients Am. J. Crit. Care., March 1, 2006; 15(2): 166 - 176. [Abstract] [Full Text] [PDF]

				L. S. Aboussouan, C. D. Lattin, and V. V. Anne Determinants of Time-To-Weaning in a Specialized Respiratory Care Unit Chest, November 1, 2005; 128(5): 3117 - 3126. [Abstract] [Full Text] [PDF]

				R. Twibell, D. Siela, and M. Mahmoodi Subjective Perceptions and Physiological Variables During Weaning From Mechanical Ventilation Am. J. Crit. Care., March 1, 2003; 12(2): 101 - 112. [Abstract] [Full Text] [PDF]

				C. D. Epstein, N. El-Mokadem, and J. R. Peerless Weaning Older Patients From Long-term Mechanical Ventilation: A Pilot Study Am. J. Crit. Care., July 1, 2002; 11(4): 369 - 377. [Abstract] [Full Text] [PDF]

				S. K. Frazier, D. K. Moser, and K. S. Stone Heart Rate Variability and Hemodynamic Alterations in Canines with Normal Cardiac Function during Exposure to Pressure Support, Continuous Positive Airway Pressure, and a Combination of Pressure Support and Continuous Positive Airway Pressure Biol Res Nurs, January 1, 2001; 2(3): 167 - 174. [Abstract] [PDF]

				S. K. Frazier, K. S. Stone, E. R. Schertel, D. K. Moser, and J. W. Pratt A Comparison of Hemodynamic Changes during the Transition from Mechanical Ventilation to T-Piece, Pressure Support, and Continuous Positive Airway Pressure in Canines Biol Res Nurs, April 1, 2000; 1(4): 253 - 264. [Abstract] [PDF]