Abstract：
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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：我们追踪了长时间机械通气（PMV）患者的断奶尝试，并探讨了与成功断奶和长期生存相关的因素。
方法：这项历史队列研究包括2015年至2018年期间入住一家康复医院的所有成年PMV患者，并根据断奶成功率随访3年或2021年底。
结果：该研究包括223名PMV患者。其中,124次（55.6%）接受了断奶尝试，69人(55.6%)成功断奶,55（44.4%）断奶失败，99名患者没有断奶尝试。平均年龄为67±20岁，39%的女性患者。年龄,各组的性别分布和入院时的白蛋白水平无显著差异.成功的断奶组比失败的断奶组的清醒患者比例高6％（55％vs.49%,分别,p=0.45)。成功断奶的患者使用抗生素治疗5天或以上的频率低于未成功断奶的患者（74％vs80％，分别,p=0.07)。从插管到气管造口术的时间超过14天的比例也较低（45％vs66％，p=0.02)。年龄,性别,抗生素治疗,气管造口术的时间超过14天，从入院到首次断奶的时间调整了成功一年的死亡率风险。断奶失败有点低，HR=0.75，95CI：0.33-1.60，p=0.45，到3年末趋势相同，HR=0.77，95CI：0.42-1.39，p=0.38。
结论：成功脱离PMV可能与更好的生存率相关，并允许长期通气的患者独立于呼吸机。需要更大的研究来进一步验证我们的发现。
方法：这项历史队列研究包括2015年至2018年期间入住一家康复医院的所有成年PMV患者，并根据断奶成功率随访3年或2021年底。
结果：该研究包括223名PMV患者。其中,124次（55.6%）接受了断奶尝试，69人(55.6%)成功断奶,55（44.4%）断奶失败，99名患者没有断奶尝试。平均年龄为67±20岁，39%的女性患者。年龄,各组的性别分布和入院时的白蛋白水平无显著差异.成功的断奶组比失败的断奶组的清醒患者比例高6％（55％vs.49%,分别,p=0.45)。成功断奶的患者使用抗生素治疗5天或以上的频率低于未成功断奶的患者（74％vs80％，分别,p=0.07)。从插管到气管造口术的时间超过14天的比例也较低（45％vs66％，p=0.02)。年龄,性别,抗生素治疗,气管造口术的时间超过14天，从入院到首次断奶的时间调整了成功一年的死亡率风险。断奶失败有点低，HR=0.75，95CI：0.33-1.60，p=0.45，到3年末趋势相同，HR=0.77，95CI：0.42-1.39，p=0.38。
结论：成功脱离PMV可能与更好的生存率相关，并允许长期通气的患者独立于呼吸机。需要更大的研究来进一步验证我们的发现。
