Hommelsheim C, Sichau M, Heipel R, Müller E, Gatermann S, Pfeifer M, Ewig S. Predictors of Outcomes in Patients with Prolonged Weaning with Focus on Respiratory Tract Pathogens and Infection.
Respiration 2018;
97:135-144. [PMID:
30332675 DOI:
10.1159/000493430]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/30/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND
The impact of respiratory tract pathogens and infection on outcomes in patients with prolonged weaning is largely unknown.
OBJECTIVE
We studied predictors of weaning outcomes (death and failure to achieve spontaneous ventilation) in a population treated during a 3.5-year period in a specialized and certified weaning centre.
METHODS
Patient data were retrieved retrospectively from the clinical charts. Complete datasets were available in 173 patients. The following parameters were investigated as potential predictors of both endpoints: age; comorbidities; tracheobronchial pathogens; bacteraemia, pneumonia and number of pneumonias; and number of inhouse treatment cycles (none vs. ≥1).
RESULTS
Tracheobronchial pathogens, pneumonia, bacteraemia and the number of antibiotic cycles all significantly increased weaning duration and hospitalisation times. Independent predictors of death were atrial fibrillation (OR 2.6, 95% CI 1.2-5.8, p = 0.02) and tracheobronchial multiresistant Pseudomonas aeruginosa (OR 3.9, 95% CI 1.4-11.0, p = 0.01). Independent predictors of failure to achieve spontaneous ventilation included chronic obstructive pulmonary disease (OR 2.8, 95% CI 1.0-7.8, p = 0.045); neuromuscular disease (OR 8.3, 95% CI 1.2-27.2, p = 0.02); tracheobronchial P. aeruginosa (OR 3.3, 95% CI 1.3-9.3, p = 0.01); Stenotrophomonas maltophilia (OR 7.9, 95% CI 1.4-51.6, p = 0.02); and pneumonia (OR 4.4, 95% CI 1.5-10.9, p = 0.003).
CONCLUSIONS
The impact of respiratory tract pathogens and infection on weaning outcomes was remarkable. Predictors of death and failure to achieve spontaneous ventilation differed considerably. A priority may be to investigate preventive strategies against colonisation and infection with respiratory pathogens, particularly P. aeruginosa.
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