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Background: As the decision-making process in long-term respiratory care units often depends on
time-based outcomes, we sought to identify independent predictors of time-to-weaning (TTW) in
a hospital-based specialized respiratory care unit.
Methods: Characteristics that were identified in previous studies as predictors of weaning success
in ICUs and long-term ventilator units were prospectively collected on 113 consecutive admis-
sions to our unit. TTW analyses were performed with Kaplan-Meier curves, log rank test, and Cox
proportional regression.
Results: The TTW was shorter in patients with static lung compliance (Cst) of > 20 mL/cm H2O,
a normal creatinine level (0.6 to 1.4 mg/dL), a rapid shallow breathing index (RSBI) of < 105,
intact skin, and in those patients from a surgical referral source. We found an interaction between
RSBI and Cst (p ⴝ 0.02) such that patients with an RSBI of < 105, regardless of Cst, had a median
TTW of 11 days, those with an RSBI of > 105 and a Cst of > 20 had a median TTW of 31 days,
and those with an RSBI of > 105 and a Cst of < 20 mL/cm H2O had not reached a median TTW
by 60 days (p ⴝ 0.007 [log rank for linear trend]). In a Cox-proportional hazard model, both this
categorization model of RSBI and Cst, and renal function had a significant impact on TTW.
Conclusions: In a multivariate model incorporating the variables reviewed, only the lung
parameters (RSBI combined with Cst) and renal function remained independently associated
with TTW. (CHEST 2005; 128:3117–3126)
Key words: acute physiology and chronic health evaluation; creatinine; lung compliance; respiratory insufficiency;
respiratory mechanics; ventilator weaning
Abbreviations: APACHE ⫽ acute physiology and chronic health evaluation; CI ⫽ confidence interval; Cst ⫽ static
lung compliance; LTAC ⫽ long-term acute care; PCU ⫽ Pulmonary Care Unit; ROC ⫽ receiver operating character-
istic; RSBI ⫽ rapid shallow breathing index; TTW ⫽ time-to-weaning
coxon rank sum]). Information on the use of differ- Figure 1. Distribution of patient disposition at hospital dis-
ent medications on admission to the PCU was charge stratified by weaning outcome. Black bars ⫽ patients who
were successfully weaned; white bars ⫽ patients who failed
available in 47% of our patients. The use of the weaning.
medications reviewed did not have a significant
impact on weaning success rates (data not shown).
Most patients were alert, with 71% of patients having tively; p ⫽ 0.03) or to have died (47% vs 7%, respec-
normal Glasgow coma score of 15 on admission to tively; p ⬍ 0.001) [Fig 1]. The most common factors
the PCU (mean ⫾ SD score: 13.2 ⫾ 3.5). However, contributing to death were infection (30%), malig-
15% of patients had severe impairment of conscious- nancy (30%), and CNS event (ie, stroke or hemor-
ness with a Glasgow coma score of ⱕ 8. Of the 79 rhage, 17%).
patients who had available blood gas measurements
on admission to the PCU, 78% had a Pao2/fraction of
Individual Predictors of TTW
inspired oxygen ratio of ⬎ 140. Overall, patients
who were successfully weaned were more likely to Factors associated with a significantly shorter time
be discharged home (16% vs 2%, respectively; from admission to the PCU to successful weaning,
p ⬍ 0.001), to a rehabilitation unit (34% vs 0%, listed in order of decreasing hazard ratio for weaning
respectively; p ⬍ 0.001), or to a nursing home (12% success, were as follows: Cst, ⬎ 20 vs ⱕ 20 mL/cm
vs 2%, respectively; p ⫽ 0.03) [Fig 1]. Alternatively, H2O; a normal creatinine level (0.6 to 1.4 mg/dL) vs
those who failed to wean were more likely to be an abnormally low creatinine level (⬍ 0.6) or an
discharged to a LTAC facility (47% vs 28%, respec- abnormally high creatinine level (⬎ 1.4 mg/dL or
Cst ⱕ 20/⬎ 20 mL/cm H2O 21 (21) 81 (80) ⬎ 177 18 2.3 (1.1–5.0) 0.02
Creatinine ⬍ 0.6 or ⬎ 1.4/0.6–1.4 mg/dL 45 (45) 54 (55) 35 10 2.2 (1.3–2.8) 0.002
RSBI ⬎ 105/ⱕ 105 47 (59) 33 (41) 35 11 1.9 (1.1–3.5) 0.02
Decubitus ulcer present/absent 41 (40) 61 (60) 31 16 1.8 (1.0–3.1) 0.03
Referral origin medical/surgical 61 (54) 52 (46) 26 11 1.7 (1.0–2.7) 0.04
APACHE score ⬎ 15/ⱕ 15 34 (33) 68 (67) 26 13 1.7 (0.97–3.1) 0.06
Ethnicity African-American/other 85 (75) 28 (25) 21 26 1.3 (0.7–2.3) 0.39
Age ⱖ 70/⬍ 70 yr 40 (35) 73 (65) 20 22 1.1 (0.7–1.9) 0.60
Ejection fraction ⬍ 50%/ⱖ 50% 28 (31) 62 (69) 26 16 1.0 (0.6–1.8) 0.99
Emphysema present/absent 21 (19) 92 (81) 21 35 0.9 (0.5–1.7) 0.77
Albumin ⱕ 2/⬎ 2 g/dL 38 (38) 62 (62) 16 18 0.8 (0.5–1.4) 0.46
*Values are given as the No. (% of available total).
†From admission to the PCU to successful weaning.
‡Category 1 comprises patients with an expected worse prognosis compared to those in category 2; the hazard ratio for TTW therefore uses
category 2 as the reference category.
§Values in parentheses are 95% CI.
㛳Log-rank p value for equality of TTW distribution.
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