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Predictors of early weaning failure from mechanical ventilation in critically ill patients after emergency gastrointestinal surgery: A retrospective study

 Yun Tae Jung  ;  Myung Jun Kim  ;  Jae Gil Lee  ;  Seung Hwan Lee 
 MEDICINE, Vol.97(40) : e12741, 2018 
Journal Title
Issue Date
Aged ; Airway Extubation/adverse effects ; Airway Extubation/methods ; Critical Care/methods* ; Critical Illness ; Digestive System Surgical Procedures ; Emergency Treatment ; Female ; Humans ; Leukocyte Count ; Male ; Middle Aged ; Neutrophils ; Odds Ratio ; Platelet Count ; Postoperative Care/methods* ; Postoperative Complications/etiology* ; Postoperative Period ; Respiration, Artificial/adverse effects* ; Retrospective Studies ; Risk Factors ; Time Factors ; Ventilator Weaning/adverse effects* ; Ventilator Weaning/methods
critically ill ; mechanical ventilation ; ventilator weaning
Mechanical ventilation (MV) is the most common therapeutic modality used for critically ill patients. However, prolonged MV is associated with high morbidity and mortality. Therefore, it is important to avoid both premature extubation and unnecessary prolongation of MV. Although some studies have determined the predictors of early weaning success and failure, only a few have investigated these factors in critically ill surgical patients who require postoperative MV. The aim of this study was to evaluate predictors of early weaning failure from MV in critically ill patients who had undergone emergency gastrointestinal (GI) surgery.The medical records of 3327 adult patients who underwent emergency GI surgery between January 2007 and December 2016 were reviewed retrospectively. Clinical and laboratory parameters before surgery and within 2 days postsurgery were investigated.This study included 387 adult patients who required postoperative MV. A low platelet count (adjusted odds ratio [OR]: 0.995; 95% confidence interval [CI]: 0.991-1.000; P = .03), an elevated delta neutrophil index (DNI; adjusted OR: 1.025; 95% CI: 1.005-1.046; P = .016), a delayed spontaneous breathing trial (SBT; adjusted OR: 14.152; 95% CI: 6.571-30.483; P < .001), and the presence of postoperative shock (adjusted OR: 2.436; 95% CI: 1.138-5.216; P = .022) were shown to predict early weaning failure from MV in the study population.Delayed SBT, a low platelet count, an elevated DNI, and the presence of postoperative shock are independent predictors of early weaning failure from MV in critically ill patients after emergency GI surgery.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myung Jun(김명준)
Lee, Seung Hwan(이승환) ORCID logo https://orcid.org/0000-0001-7325-8262
Lee, Jae Gil(이재길) ORCID logo https://orcid.org/0000-0002-1148-8035
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