Indicators of different outcomes after prolonged weaning: results from a specialist weaning centre

<bold>Background:</bold> The outcomes of prolonged weaning in a specialist weaning centre range from successful weaning from IMV without NIV (3a), with NIV (3b), weaning failure with continued IMV (3cI) and death (3cII). We aimed to identify indicators for the different outcomes. <bold>Methods:</bold> We analysed patients who underwent prolonged weaning at Thoraxclinic Heidelberg from Dec. 08 to Dec. 23 for the four weaning outcome categories: 3a, 3b, 3cI and 3cII. Independent risk factors for the listed outcomes were assessed using binary logistic regression analyses. <bold>Results:</bold> During the study period, a total of 915 patients (71.4±14.5 years, 39.3% female) underwent prolonged weaning. 73.3% of patients were successfully weaned, 36.1% without NIV and 37.2% with NIV. Of those with weaning failure, 20.2% were discharged with IMV and 6.6% died in the weaning centre. Independent indicators (p=0.005 each) of weaning category 3a were low BMI and low pCO2 levels before the first SBT, absence of: NMD or COPD as the cause of IMV as well as pre-diagnosis of COPD or thoracic restrictive disease. Indicators of category 3b were older age, higher BMI, lower FiO2 and higher pCO2 at first SBT, initiation of IMV for AECOPD and pre-diagnosis of COPD, whereas patients with malignancy were less likely to fall into this category. Indicators of category 3cI were duration of previous IMV, NMD as the cause of IMV, thoracorestrictive disease and renal insufficiency. Only renal insufficiency and pre-diagnosed malignancy were indicators of category 3cII. <bold>Conclusion:</bold> There are specific risk factors for each weaning outcome and early assessment of each patient's individual risk profile can help plan further outpatient care.