Risk Factors Associated with Failure of Weaning from Invasive Mechanical Ventilation in Gerontal Patients with Acute Exacerbation of COPD_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YangJiawen ¹ , WangZongqiang ² ,  WangXiaohua ¹

1. Department of Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, 519000, China;
2. ;

Corresponding?author：

WangXiaohua, Email: wxh70662@sohu.com

Keywords：

Chronic obstructive pulmonary disease; Mechanical ventilation; Ventilator weaning

DOI：

10.7507/1671-6205.2015005

Video：

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Objective To investigate the risk factors associated with failure of weaning from invasive mechanical ventilation in gerontal patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A retrospective study was conducted on 76 patients aged 65 years and older with AECOPD who received invasive mechanical ventilation and met the weaning criteria from July 2012 to June 2014. The subjects who passed the spontaneously breathing trial (SBT) and did not need mechanical ventilation within 48 h were enrolled into a weaning success group. The subjects who did not pass the SBT or needed mechanical ventilation again within 48 h were enrolled into a weaning failure group. The risk factors associated with failure of weaning were studied by univariate and multivariate Logistic regression analysis. Results There were 53 subjects in the weaning success group and 23 in the weaning failure group. The incidences of sepsis, multiple organ dysfunction syndrome (MODS), fungal infection, hypoproteinemia, duration for mechanical ventilation > 14 d, the prevalences of aeropleura, cardiac failure, diabetes, coronary heart disease and hepatic insufficiency were higher in the weaning failure group than those in the weaning success group (P < 0.05). Logistic analysis revealed that MODS (OR=8.070), duration for mechanical ventilation > 14 d (OR=17.760), cardiac failure (OR=4.597) and diabetes (OR=13.937) were risk factors of weaning failure (P < 0.05). Conclusion MODS, duration for mechanical ventilation > 14 d, cardiac failure and diabetes were associated with the failure of weaning from invasive mechanical ventilation in gerontal patients with AECOPD.

Citation： YangJiawen, WangZongqiang, WangXiaohua. Risk Factors Associated with Failure of Weaning from Invasive Mechanical Ventilation in Gerontal Patients with Acute Exacerbation of COPD. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(1): 13-16. doi: 10.7507/1671-6205.2015005 Copy

1.	Vestbo J, Hurd SS, Agustí AG, et al.Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease:GOLD executive summary.Am J Respir Crit Care Med, 2013, 187:347-365.
2.	Calverley PM, Walker P.Chronic obstructive pulmonary diseases.Lancet, 2003, 362:1053-1061.
3.	Tsiligianni IG, Kosmas E, Van der Molen T, et al.Managing comorbidity in COPD:a difficult task.Curr Drug Targets, 2013, 14:158-176.
4.	Jungblut SA, Heidelmann LM, Westerfeld A, et al.Ventilation therapy for patients suffering from obstructive lung diseases.Recent Pat Inflamm Allergy Drug Discov, 2014, 8:1-8.
5.	中華醫學會重癥醫學分會.機械通氣臨床應用指南(2006).中國危重病急救醫學, 2007, 19:65-72.
6.	Farah R, Makhoul N.Optimal time needed for withdrawal of mechanical ventilation in patients with chronic obstructive pulmonary disease.Isr Med Assoc J, 2011, 13:609-612.
7.	中華醫學會重癥醫學分會.慢性阻塞性肺疾病急性加重患者的機械通氣指南(2007).中國危重病急救醫學, 2007, 19:513-518.
8.	中華醫學會呼吸病學分會慢性阻塞性肺疾病學組.慢性阻塞性肺疾病診治指南(2007年修訂版).中華結核和呼吸雜志, 2007, 30:8-17.
9.	姚詠明, 盛志勇, 林洪遠, 等.膿毒癥定義及診斷的新認識.中國危重病急救醫學, 2004, 16:321-324.
10.	北京市科委重大項目"MODS中西醫結合診治/降低病死率研究"課題組.多器官功能障礙綜合征診斷標準、病情嚴重度評分及預后評估系統和中西醫結合證型診斷.中國危重病急救醫學, 2008, 20:1-3.
11.	中華醫學會重癥醫學分會.重癥患者侵襲性真菌病感染診斷與治療指南(2007).中華內科雜志, 2007, 46:960-966.
12.	中華醫學會心血管病學分會中華心血管病雜志編輯委員會.急性心力衰竭診斷和治療指南.中華心血管病雜志, 2010, 38:195-208.
13.	中華醫學會心血管病學分會中華心血管病雜志編輯委員會.慢性心力衰竭診斷和治療指南.中華心血管病雜志, 2010, 38:1076-1095.
14.	中國高血壓防治指南修訂委員會.中國高血壓防治指南2010.中華高血壓雜志, 2011, 19:701-743.
15.	中華醫學會心血管病學分會中華心血管病雜志編輯委員會.慢性穩定性心絞痛診斷與治療指南.中華心血管病雜志, 2007, 35:195-206.
16.	中華醫學會心血管病學分會中華心血管病雜志編輯委員會.不穩定性心絞痛和非ST段抬高心肌梗死診斷與治療指南.中華心血管病雜志, 2007, 35:295-304.
17.	中華醫學會糖尿病學分會.中國2型糖尿病防治指南(2010年版).中國醫學前沿雜志(電子版), 2011, 3:54-109.
18.	成人支氣管擴張癥診治專家共識編寫組.成人支氣管擴張癥診治專家共識.中華結核和呼吸雜志, 2012, 35:485-492.
19.	Hardman JG, Aitkenhead AR.Estimation of alveolar deadspace fraction using arterial and end-tidal CO₂:a factor analysis using a physiological simulation.Anaesth Intensive Care, 1999, 27:452-458.
20.	Tobin MJ, Laghi F, Brochard L.Role of the respiratory muscles in acute respiratory failure of COPD:lessons from weaning failure.J Appl Physiol, 2009, 10:962-970.
21.	王新華, 周榮斌.老年膿毒癥的免疫病理及臨床特點.中華老年多器官疾病雜志, 2010, 9:374-376.
22.	牛穎梅, 童朝暉.慢性阻塞性肺疾病合并侵襲性肺曲霉病的研究進展.中華結核和呼吸雜志, 2009, 32:295-297.
23.	陳葆青.老年慢性阻塞性肺疾病繼發肺部真菌感染的危險因素分析.中國老年學雜志, 2009, 29:2099-2101.
24.	Bafadhel M, McKenna S, Agbetile J, et al.Aspergillus fumigatus during stable state and exacerbations of COPD.Eur Respir J, 2014, 43:64-71.
25.	王勝軍, 孫霓, 孫曉佳, 等.老年重癥患者低蛋白血癥的相關臨床指標分析.中國老年學雜志, 2011, 31:4135-4137.
26.	牛志偉, 孫海峰, 陳希勝.慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者有創機械通氣持續時間影響因素分析.中國呼吸與危重監護雜志, 2009, 8:36-39.
27.	Mannino DM, Thorn D, Swensen A, et al.Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD.Eur Respir J, 2008, 32:962-969.
28.	張納新, 王平, 秦英智.249例機械通氣患者脫機失敗原因分析.中國危重病急救醫學, 2001, 13:116-117.

1. Vestbo J, Hurd SS, Agustí AG, et al.Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease:GOLD executive summary.Am J Respir Crit Care Med, 2013, 187:347-365.
2. Calverley PM, Walker P.Chronic obstructive pulmonary diseases.Lancet, 2003, 362:1053-1061.
3. Tsiligianni IG, Kosmas E, Van der Molen T, et al.Managing comorbidity in COPD:a difficult task.Curr Drug Targets, 2013, 14:158-176.
4. Jungblut SA, Heidelmann LM, Westerfeld A, et al.Ventilation therapy for patients suffering from obstructive lung diseases.Recent Pat Inflamm Allergy Drug Discov, 2014, 8:1-8.
5. 中華醫學會重癥醫學分會.機械通氣臨床應用指南(2006).中國危重病急救醫學, 2007, 19:65-72.
6. Farah R, Makhoul N.Optimal time needed for withdrawal of mechanical ventilation in patients with chronic obstructive pulmonary disease.Isr Med Assoc J, 2011, 13:609-612.
7. 中華醫學會重癥醫學分會.慢性阻塞性肺疾病急性加重患者的機械通氣指南(2007).中國危重病急救醫學, 2007, 19:513-518.
8. 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組.慢性阻塞性肺疾病診治指南(2007年修訂版).中華結核和呼吸雜志, 2007, 30:8-17.
9. 姚詠明, 盛志勇, 林洪遠, 等.膿毒癥定義及診斷的新認識.中國危重病急救醫學, 2004, 16:321-324.
10. 北京市科委重大項目"MODS中西醫結合診治/降低病死率研究"課題組.多器官功能障礙綜合征診斷標準、病情嚴重度評分及預后評估系統和中西醫結合證型診斷.中國危重病急救醫學, 2008, 20:1-3.
11. 中華醫學會重癥醫學分會.重癥患者侵襲性真菌病感染診斷與治療指南(2007).中華內科雜志, 2007, 46:960-966.
12. 中華醫學會心血管病學分會中華心血管病雜志編輯委員會.急性心力衰竭診斷和治療指南.中華心血管病雜志, 2010, 38:195-208.
13. 中華醫學會心血管病學分會中華心血管病雜志編輯委員會.慢性心力衰竭診斷和治療指南.中華心血管病雜志, 2010, 38:1076-1095.
14. 中國高血壓防治指南修訂委員會.中國高血壓防治指南2010.中華高血壓雜志, 2011, 19:701-743.
15. 中華醫學會心血管病學分會中華心血管病雜志編輯委員會.慢性穩定性心絞痛診斷與治療指南.中華心血管病雜志, 2007, 35:195-206.
16. 中華醫學會心血管病學分會中華心血管病雜志編輯委員會.不穩定性心絞痛和非ST段抬高心肌梗死診斷與治療指南.中華心血管病雜志, 2007, 35:295-304.
17. 中華醫學會糖尿病學分會.中國2型糖尿病防治指南(2010年版).中國醫學前沿雜志(電子版), 2011, 3:54-109.
18. 成人支氣管擴張癥診治專家共識編寫組.成人支氣管擴張癥診治專家共識.中華結核和呼吸雜志, 2012, 35:485-492.
19. Hardman JG, Aitkenhead AR.Estimation of alveolar deadspace fraction using arterial and end-tidal CO₂:a factor analysis using a physiological simulation.Anaesth Intensive Care, 1999, 27:452-458.
20. Tobin MJ, Laghi F, Brochard L.Role of the respiratory muscles in acute respiratory failure of COPD:lessons from weaning failure.J Appl Physiol, 2009, 10:962-970.
21. 王新華, 周榮斌.老年膿毒癥的免疫病理及臨床特點.中華老年多器官疾病雜志, 2010, 9:374-376.
22. 牛穎梅, 童朝暉.慢性阻塞性肺疾病合并侵襲性肺曲霉病的研究進展.中華結核和呼吸雜志, 2009, 32:295-297.
23. 陳葆青.老年慢性阻塞性肺疾病繼發肺部真菌感染的危險因素分析.中國老年學雜志, 2009, 29:2099-2101.
24. Bafadhel M, McKenna S, Agbetile J, et al.Aspergillus fumigatus during stable state and exacerbations of COPD.Eur Respir J, 2014, 43:64-71.
25. 王勝軍, 孫霓, 孫曉佳, 等.老年重癥患者低蛋白血癥的相關臨床指標分析.中國老年學雜志, 2011, 31:4135-4137.
26. 牛志偉, 孫海峰, 陳希勝.慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者有創機械通氣持續時間影響因素分析.中國呼吸與危重監護雜志, 2009, 8:36-39.
27. Mannino DM, Thorn D, Swensen A, et al.Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD.Eur Respir J, 2008, 32:962-969.
28. 張納新, 王平, 秦英智.249例機械通氣患者脫機失敗原因分析.中國危重病急救醫學, 2001, 13:116-117.

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Risk Factors Associated with Failure of Weaning from Invasive Mechanical Ventilation in Gerontal Patients with Acute Exacerbation of COPD

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