The relationship between mechanical power normalized to dynamic lung compliance and weaning outcomes in mechanically ventilated patients

• Published in: PloS one Vol. 19; no. 8; p. e0306116
• Main Authors: Yan, Yao, Du, Zhiqiang, Chen, Haoran, Liu, Suxia, Chen, Xiaobing, Li, Xiaomin, Xie, Yongpeng
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 22-08-2024; Public Library of Science (PLoS)
• Subjects: Aged; Artificial respiration; Biology and Life Sciences; Blood pressure; Body mass index; Body size; Care and treatment; Chronic obstructive pulmonary disease; Complications and side effects; Computer and Information Sciences; Diagnosis; Engineering and Technology; Extubation; Failure analysis; Female; Humans; Intensive care; Intubation; Load; Lung Compliance; Lung diseases; Lungs; Male; Mechanical ventilation; Medical advice systems; Medicine and Health Sciences; Middle Aged; Missing data; Mortality; Mortality risk; Patient compliance; Patient outcomes; Patients; Physical Sciences; Physiology; Political aspects; Quartiles; Regression analysis; Research and Analysis Methods; Respiration, Artificial - methods; Respiratory system; Retrospective Studies; Sensitivity analysis; Strategy; Subgroups; Variables; Ventilation; Ventilator Weaning - methods; Ventilators; Weaning; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0306116

Prolonged mechanical ventilation is associated with an increased risk of mortality in these patients. However, there exists a significant clinical need for novel indicators that can complement traditional weaning evaluation methods and effectively guide ventilator weaning.
To investigate the specific relationship between mechanical power normalized to dynamic lung compliance (Cdyn-MP) and weaning outcomes in patients on mechanical ventilation for more than 24 hours, as well as those who underwent a T-tube weaning strategy.
A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care-IV v1.0 database (MIMIC-IV v1.0). Patients who received invasive mechanical ventilation for more than 24 hours and underwent a T-tube ventilation strategy for weaning were enrolled. Patients were divided into two groups based on their weaning outcome: weaning success and failure. Ventilation parameter data were collected every 4 hours during the first 24 hours before the first spontaneous breathing trial (SBT).
Of all the 3,695 patients, 1,421 (38.5%) experienced weaning failure. Univariate logistic regression analysis revealed that the risk of weaning failure increased as the Cdyn-MP level rose (OR 1.34, 95% CI 1.31-1.38, P<0.001). After adjusting for age, body mass index, disease severity, and pre-weaning disease status, patients with high Cdyn-MP quartiles in the 4 hours prior to the SBT had a significantly greater risk of weaning failure than those with low Cdyn-MP quartiles (odds ratio 10.37, 95% CI 7.56-14.24). These findings were robust and consistent in both subgroup and sensitivity analyses.
The increased Cdyn-MP before SBT was independently associated with a higher risk of weaning failure in mechanically ventilated patients. Cdyn-MP has the potential to be a useful indicator for guiding the need for ventilator weaning and complementing traditional weaning evaluation methods.