Risk Factors for Weaning Failure in COVID-19 Patients

	Weaning Success (N=61)	Weaning Failure (N=97)	P Value
Age, years	62.39 (59.1–65.66)	67.41 (65.22–69.61)	0.02
Men, n (%)	42 (68.9)	61 (62.96)	0.49
APACHE II score Day 0	14.87 (13.46–16.28)	16.46 (15.19–17.72)	0.12
SOFA score Day 0	7.2 (6.67–7.75)	8.24 (7.70–8.77)	0.02
Heart failure, n (%)	4 (6.5)	18 (18.5)	0.03
Diabetes mellitus, n (%)	13 (21.3)	14 (14.4)	0.28
Hypertension, n (%)	31 (50.8)	46 (47.4)	0.74
COPD, n (%)	4 (6.5)	20 (20.6)	0.02
Immunosuppression, n (%)	2 (3.2)	12 (12.3)	0.08
Corticosteroids, mg/Kg/Day^a	0.95 (0.65–1.26)	0.93 (0.69–1.18)	0.66
PO₂/FiO₂, mmHg	142.9 (123.2–162.5)	124.9 (97.89–151.9)	0.25
Mechanical ventilation duration, days	7.6 (6.1–9.07)	12.9 (11.06–14.73)	<0.0001
Vt ml/Kg^b	5.80 (5.30–6.30)	6.26 (6.02–6.51)	0.058
Pplat, ICU Day 0, cmH₂O	22.85 (21.52–24.18)	25.28 (23.89–26.66)	0.04
Driving Pressure, ICU Day 0, cm H₂O	11.1 (10.3–11.9)	13.02 (11.84–14.21)	0.03
PEEP ICU Day 0, cmH₂O	10.54 (9.65–11.42)	10.21 (9.52–10.90)	0.38
PEEP >12 cmH₂O (Day 0–7), hours	43.53 (28.02–59.03)	55.11 (41.30–68.92)	0.28
Fluid Balance ICU Days 0–7, lit	3.44 (1.17–5.71)	6.17 (4.2–8.13)	0.04
SARS-CoV-2 pneumonia, n (%)	42 (68.8)	54 (55.7)	0.13
Temperature >38.5 °C, hours	21.34 (10.99–31.70)	28.19 (16.70–39.69)	0.56
VAP, n (%)	29 (47.5)	33 (34)	0.09
VAP^c	153 (17.31)	191 (21.61)	<0.0001
BSI, n (%)	22 (36)	46 (47.4)	0.18
BSI^d	116 (13.11)	266 (30.06)	0.001
Shock, n (%)	20 (32.7)	59 (60.8)	0.001
Septic – VAP, n (%)	4 (20)	5 (8.5)
Septic – BSI, n (%)	6 (30)	16 (27.1)
Septic – VAP&BSI, n (%)	6 (30)	15 (25.4)
Unclear^*, n (%)	3 (15)	24 (40.7)
ICU antibiotics course, days^e	18.56 (15.78–21.34)	16.55 (14.25–18.84)	0.13
ICU mortality 28^th day, n (%)	6 (9.8)	67 (69)	<0.0001
ICU length of stay, days	18.87 (16.17–21.56)	17.25 (14.89–19.61)	0.12

Values are mean (interquartile range) otherwise is indicated.

a Equivalent of hydrocortisone;

b Vt is based on the ideal weight of 75Kg per patient;

c VAP as VAP events / mean of ICU stay * 100;

d BSI as BSI events/ mean of ICU stay * 100;

e At least one antibiotic;

* Absence of microbiological documentation or, of another positive diagnostic test or, more than one cause were recorded i.e. cardiogenic and distributive secondary to pharmacologic effects;

ICU Intensive Care Unit, COPD Chronic Obstructive Pulmonary Disease, VAP Ventilator associated Pneumonia, BSI Bloodstream Infection Vt Tidal Volume, ARDS Acute Respiratory Distress Syndrome, SOFA Sequential Organ Failure Assessment, APACHE II Acute Physiology and Chronic Health Disease Classification System I, Pplat plateau airway pressure, PEEP Positive End-Expiratory Pressure

Table 2.

Characteristics of SARS-CoV2 ARDS patients according to weaning outcome.

	Weaning Success (N=42)	Weaning Failure (N=54)	P Value
Age, years	61.26 (57.12–65.41)	68.98 (65.89–72.08)	0.003
Men, n (%)	28(66.7)	33(61.1)	0.67
APACHE II score ICU Day 0	14.38 (12.95–15.81)	15.69 (14.34–17.03)	0.15
SOFA score ICU Day 0	7.4 (6.80–8.09)	8.2 (7.56–8.84)	0.16
Heart failure, n (%)	2 (4.7)	7 (12.3)	0.29
Diabetes mellitus, n (%)	9 (21.4)	17 (31.5)	0.35
Hypertension, n (%)	20 (47.6)	27 (50)	0.84
COPD, n (%)	2 (4.8)	11 (20.4)	0.03
Immunosuppression, n (%)	0 (0.0)	6 (11.1)	0.03
Corticosteroids, mg/kg/Day^a	1.13 (0.77–1.49)	1.43 (1.07–1.80)	0.29
PO₂/FiO₂, mmHg	148.9 (123.8–174)	106.1 (75.68–136.5)	0.02
Mechanical ventilation duration, days	7.59 (5.91–9.27)	11.56 (9.17–13.92)	0.006
Vt ml/Kg^b	5.80 (5.27–6.34)	6.39 (6.18–6.11)	0.13
Pplat, ICU Day 0, cmH₂O	22.67 (21.23–24.1)	25.37 (23.91–26.88)	0.016
Driving Pressure, ICU Day 0, cm H₂O	10.92 (10.11–11.72)	13.02 (11.84–14.21)	0.017
PEEP ICU Day 0, cmH₂O	11.45 (10.39–12.51)	11.94 (11.13–12.76)	0.63
PEEP >12 cmH₂O (Day 0–7), hours	61.5 (41.83–81.17)	82.17 (62.55–101.7)	0.11
Fluid Balance ICU Days 0–7, lit	2.71 (−0.1–5.51)	3.74 (1.17–5.80)	0.3
Temperature >38.5°C, hours	22.36 (10.88–33.83)	14.56 (4.61–24.50)	0.14
VAP, n (%)	22 (53.6)	15 (27.8)	0.01
VAP^c	126 (19.35)	110 (16.90)	<0.0001
BSI, n (%)	15 (36.6)	25 (46.3)	0.4
BSI^d	86 (13.23)	183 (28.15)	0.02
Shock, n (%)	12 (29.2)	39 (72.2)	<0.0001
VAP, n (%)	3 (25)	4 (10.2)
BSI, n (%)	2 (16.6)	11 (28.2)
VAP and BSI, n (%)	5 (41.6)	8 (20.5)
Unclear^*, n (%)	2 (16.6)	15 (38.4)
ICU antibiotics course, days^e	16.5 (13.86–19.14)	13.13 (10.60–15.66)	0.02
ICU mortality 28^th day, n (%)	4 (9.7)	42 (77.8)	<0.0001
ICU length of stay, days	17.44 (14.87–20)	13.65 (11.18–16.12)	0.01

Values are mean (interquartile range) otherwise is indicated.

a Equivalent of hydrocortisone;

b Vt is based on the ideal weight of 75Kg per patient;

c VAP as VAP events / mean of ICU stay * 100;

d BSI as BSI events/mean of ICU stay * 100;

e At least one antibiotic;

* Absence of microbiological documentation or, of another positive diagnostic test or, more than one cause were recorded i.e. cardiogenic and distributive secondary to pharmacologic effects;

Table 3.

Results of binary regression analysis of risk factors associated with weaning success in the total population

Variables	S.E	P value	O.R	Lower 95%C.I	Upper 95% C.I
COPD	0.61	0.03	0.27	0.08	0.89
SOFA score	0.08	0.04	0.86	0.73	0.99
Shock	0.37	0.001	0.3	0.14	0.61

[i] COPD Chronic Obstructive Pulmonary Disease, SOFA Sequential Organ Failure Assessment; S.E Standard Error, O.R Odds Ratio, C.I Confidence Interval

Table 4.

Results of binary regression analyses of risk factors associated with weaning success in SARS-CoV2 ARDS patients and ARDS patients

Variables	S.E	P value	O.R	Lower 95% C.I	Upper 95% C.I
SARS-CoV2 ARDS
COPD	0.85	0.04	0.18	0.03	0.96
SOFA score	0.11	0.17	0.86	0.69	1.06
Shock	0.49	0.02	0.33	0.12	0.86
ARDS
COPD	0.86	0.36	0.46	0.08	2.44
SOFA score	0.11	0.07	0.82	0.66	1.01
Shock	0.59	0.71	0.8	0.25	2.55

[i] COPD Chronic Obstructive Pulmonary Disease, SOFA Sequential Organ Failure Assessment; S.E Standard Error, O.R Odds Ratio, C.I Confidence Interval

References

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Articles in this issue

DOI: https://doi.org/10.2478/jccm-2023-0021 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809

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Language: English

Page range: 170 - 177

Submitted on: Oct 22, 2022

Accepted on: Jul 21, 2023

Published on: Jul 31, 2023

Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

COVID-19,

weaning,

risk factors,

shock,

COPD,

Related subjects:

Internal medicine, other,

Surgery,

Surgery, other,

Anaesthesiology,

Emergency medicine and intensive-care medicine

© 2023 Effrosyni Gerovasileiou, Apostolis-Alkiviadis Menis, George Gavriilidis, Eleni Magira, Prodromos Temperikidis, Sofia Papoti, Nikitas Karavidas, Michael Spanos, Epaminondas Zakynthinos, Demosthenes Makris, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 9 (2023): Issue 3 (July 2023)