Incidence, causes, and predictors of unsuccessful decannulation following prolonged weaning.
dysphagia
mechanical ventilation
non-invasive ventilation
tracheostomy
ventilator weaning
Journal
Therapeutic advances in chronic disease
ISSN: 2040-6223
Titre abrégé: Ther Adv Chronic Dis
Pays: United States
ID NLM: 101532140
Informations de publication
Date de publication:
2022
2022
Historique:
received:
23
03
2022
accepted:
06
06
2022
entrez:
12
8
2022
pubmed:
13
8
2022
medline:
13
8
2022
Statut:
epublish
Résumé
Liberation from prolonged tracheostomy ventilation involves ventilator weaning and removal of the tracheal cannula (referred to as decannulation). This study evaluated the incidence, causes, and predictors of unsuccessful decannulation following prolonged weaning. Observational retrospective cohort study of 532 prolonged mechanically ventilated, tracheotomized patients treated at a specialized weaning center between June 2013 and January 2021. We summarized the causes for unsuccessful decannulations and used a binary logistic regression analysis to derive and validate associated predictors. Failure to decannulate occurred in 216 patients (41%). The main causes were severe intensive care unit (ICU)-acquired dysphagia (64%), long-term ventilator dependence following weaning failure (41%), excessive respiratory secretions (12%), unconsciousness (4%), and airway obstruction (3%). Predictors of unsuccessful decannulation from any cause were age [odds ratio (OR) = 1.04 year Failure to decannulate after prolonged weaning occurred in 41%, mainly resulting from persistent ICU-acquired dysphagia and long-term ventilator dependence following weaning failure, each associated with its own set of predictors.
Sections du résumé
Background
UNASSIGNED
Liberation from prolonged tracheostomy ventilation involves ventilator weaning and removal of the tracheal cannula (referred to as decannulation). This study evaluated the incidence, causes, and predictors of unsuccessful decannulation following prolonged weaning.
Methods
UNASSIGNED
Observational retrospective cohort study of 532 prolonged mechanically ventilated, tracheotomized patients treated at a specialized weaning center between June 2013 and January 2021. We summarized the causes for unsuccessful decannulations and used a binary logistic regression analysis to derive and validate associated predictors.
Results
UNASSIGNED
Failure to decannulate occurred in 216 patients (41%). The main causes were severe intensive care unit (ICU)-acquired dysphagia (64%), long-term ventilator dependence following weaning failure (41%), excessive respiratory secretions (12%), unconsciousness (4%), and airway obstruction (3%). Predictors of unsuccessful decannulation from any cause were age [odds ratio (OR) = 1.04 year
Conclusion
UNASSIGNED
Failure to decannulate after prolonged weaning occurred in 41%, mainly resulting from persistent ICU-acquired dysphagia and long-term ventilator dependence following weaning failure, each associated with its own set of predictors.
Identifiants
pubmed: 35959504
doi: 10.1177/20406223221109655
pii: 10.1177_20406223221109655
pmc: PMC9358569
doi:
Types de publication
Journal Article
Langues
eng
Pagination
20406223221109655Informations de copyright
© The Author(s), 2022.
Déclaration de conflit d'intérêts
Competing interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Références
Eur Respir J. 2007 May;29(5):1033-56
pubmed: 17470624
ERJ Open Res. 2016 Oct 28;2(4):
pubmed: 28053973
Ann Intensive Care. 2018 Mar 16;8(1):38
pubmed: 29549456
Crit Care. 2011;15(5):R231
pubmed: 21958475
J Intensive Care. 2020 Feb 21;8:19
pubmed: 32123565
N Engl J Med. 2020 Sep 10;383(11):1009-1017
pubmed: 32905673
Am J Respir Crit Care Med. 2001 Aug 15;164(4):638-41
pubmed: 11520729
Crit Care Med. 2013 Oct;41(10):2396-405
pubmed: 23939361
Pulmonology. 2019 Nov - Dec;25(6):328-333
pubmed: 31519534
Multidiscip Respir Med. 2015 Nov 27;10:35
pubmed: 26629342
Intensive Care Med. 2003 May;29(5):845-8
pubmed: 12634987
J Intensive Care Med. 2009 May-Jun;24(3):187-94
pubmed: 19282297
Respir Res. 2021 Apr 28;22(1):131
pubmed: 33910566
Respiration. 2018;96(1):66-97
pubmed: 29945148
Eur Arch Otorhinolaryngol. 2014 Nov;271(11):3085-93
pubmed: 24970291
Dysphagia. 2014 Dec;29(6):647-54
pubmed: 25119447
Med Intensiva. 2012 Nov;36(8):531-9
pubmed: 22398327
J Clin Epidemiol. 2015 Feb;68(2):134-43
pubmed: 25579640
Pulmonology. 2021 Jan-Feb;27(1):43-51
pubmed: 32723618
Crit Care. 2008;12(1):R26
pubmed: 18302759
Aust Crit Care. 2009 Feb;22(1):8-15
pubmed: 19062302
Dysphagia. 1996 Spring;11(2):93-8
pubmed: 8721066
JAMA. 2013 Feb 20;309(7):671-7
pubmed: 23340588
BMC Pulm Med. 2022 Jan 6;22(1):24
pubmed: 34991555
BMC Pulm Med. 2021 Jun 17;21(1):202
pubmed: 34140018
Chest. 2010 Mar;137(3):665-73
pubmed: 20202948
J Crit Care. 2014 Aug;29(4):695.e9-14
pubmed: 24793660
Am J Respir Crit Care Med. 2019 Jun 15;199(12):1508-1516
pubmed: 30624956
Crit Care Med. 2017 Dec;45(12):2061-2069
pubmed: 29023260
Multidiscip Respir Med. 2014 Jun 20;9(1):36
pubmed: 25006457
Dysphagia. 2016 Dec;31(6):721-729
pubmed: 27530728
Respiration. 2020 Dec 10;:1-102
pubmed: 33302267
BMC Pulm Med. 2014 Dec 15;14:201
pubmed: 25510483
BMC Anesthesiol. 2018 Jun 13;18(1):65
pubmed: 29898662
J Intensive Care. 2018 Oct 16;6:67
pubmed: 30349727