A historical cohort study on predictors for successful weaning from prolonged mechanical ventilation and up to 3-year survival follow-up in a rehabilitation center.

BACKGROUND: We followed prolonged mechanically ventilated (PMV) patients for weaning attempts and explored factors associated with successful weaning and long-term survival.

METHODS: This historical cohort study included all adult PMV patients admitted to a single rehabilitation hospital during 2015-2018 and followed for survival according to weaning success up to 3 years or the end of 2021.

RESULTS: The study included 223 PMV patients. Of them, 124(55.6%) underwent weaning attempts, with 69(55.6%) successfully weaned, 55(44.4%) unsuccessfully weaned, and 99 patients with no weaning attempts. The mean age was 67±20 years, with 39% female patients. Age, sex distributions and albumin levels at admission were not significantly different among the groups. The successful weaning group had a 6% higher proportion of conscious patients than the failed weaning group (55% vs. 49%, respectively, p=0.45). Patients successfully weaned were less frequently treated with antibiotics for 5 days or more than those unsuccessfully weaned (74% vs 80%, respectively, p=0.07). They also had a lower proportion of time from intubation to tracheostomy greater than 14 days (45% vs 66%, p=0.02). The age, sex, antibiotic treatment, time to tracheostomy exceeding 14 days and time from admission to first weaning attempt adjusted one-year mortality risk of successful vs. failed weaning was somewhat lower, HR=0.75, 95%CI: 0.33-1.60, p=0.45, with the same trend by the end of 3 years, HR=0.77, 95%CI: 0.42-1.39, p=0.38.

CONCLUSION: Successful weaning from PMV may be associated with better survival and allows chronically ventilated patients to become independent on a ventilator. A larger study is needed to further validate our findings.