Epidemiology of Weaning From Invasive Mechanical Ventilation in Subjects With COVID-19.
Level 3 - non-randomized controlled study
Multicenter prospective observational cohort study
PubMed 36379638 · doi:10.4187/respcare.09925
What was done
A multicenter, prospective cohort study was conducted across 8 intensive care units (ICUs) to evaluate weaning characteristics in adult patients with COVID-19-induced acute respiratory failure requiring invasive mechanical ventilation for at least 12 hours. Weaning categories and clinical outcomes were classified using the Weaning according to a New Definition (WIND) framework.
What was found
Among 326 included subjects, 52.1% never underwent a spontaneous breathing trial (SBT). A total of 128 subjects were extubated, of whom 29.7% required re-intubation. Patients were classified into WIND groups: Group 0 (52.1%), Group 1 (28.5%), Group 2 (8.0%), and Group 3 (11.3%). Statistically significant differences across these groups were observed for duration of mechanical ventilation (P < .001) and ICU length of stay (P < .001).
Why it matters
This study provides prospective multicenter epidemiology on mechanical ventilation liberation in COVID-19 acute respiratory failure, showing that over half never attempted an SBT and nearly a third of extubated patients failed extubation.
Limits
The study is observational and lacks a non-COVID-19 control cohort. Specific reasons for withholding spontaneous breathing trials, causes of extubation failure, and long-term mortality data are not provided in the abstract.
Cited by
- supports Before COVID-19, the average time an ICU patient spent on a ventilator was 3 to 4 days, whereas COVID-19 patients spend 11 to 21 days on mechanical ventilation.