Journal: |
Egyptian Journal of Chest Diseases and Tuberculosis
Elsevier
|
Volume: |
|
Abstract: |
Background: It was reported that nearly twenty percent of all initial weaning trials in
mechanically ventilated chronic obstructive pulmonary disease patients failed, which may lead to
prolonged mechanical ventilation and expose the patient to hazardous complications such as ventilator
associated pneumonia, critical illness neuromuscular abnormalities and ICU psychosis rather
than the complications of mechanical ventilation itself.
Methods: This study was carried out at the Respiratory Intensive Care Unit of Chest Department,
Zagazig University Hospitals from May 2013 to May 2015. It included Mechanically ventilated
chronic obstructive pulmonary disease patients due to acute respiratory failure who
underwent first weaning trial using two hours of spontaneous breathing trial through T piece. They
were 60 patients, 44 males and 16 females with an age range from 41 to 65 years and a mean age of
54.23 ±6.41 years. At the end of the first weaning trial, patients were classified into two groups
according to weaning outcome: Group I: (successful weaning) as a control group they were (20)
patients and Group II: (failed weaning) they were (40) patients. Various risk factors were assessed
including electrolyte imbalance, nutritional state, delirium, weaning induced myocardial ischemia
and impaired thyroid function beside calculation of APACHE II score to assess illness severity.
Results: This study reported significant risk factors for weaning failure including: malnutrition
(62.5%), electrolyte imbalance (42.5%), myocardial ischemia (37.5%), hypoalbuminemia
(32.5%), hypothyroidism (25%), delirium (20%) and overfeeding (17.5%) while in 5% of the studied
patients no identified risk factor was observed. In this work, multiple regression analysis isolated
two independent risk factors for weaning failure in COPD patients including, TSH level
>2.65 mIU/ml and impaired nutritional status, with P value = (0.018, 0.048) respectively.
Conclusions: 1-Myocardial ischemia, delirium, hypomagnesemia, hypophosphatemia and VAP
could be considered as important risk factors for weaning failure, however high TSH level
>2.65 mIU/ml and abnormal nutritional state were the most valuable independent predictors for
weaning failure. 2-An increase in the degree of severity of illness on ICU admission APACHE II score), previous mechanical ventilation and longer duration of mechanical ventilation
could intensify the risk for weaning failure. 3-RSBI below 85 breaths/min/L may increase the rate of
weaning success.(guided by
|
|
|