Introduction
Methods
Study population
Standardized weaning process
Weaning classification by ICC and WIND
Weaning outcomes
Statistical analysis
Results
Application of ICC and WIND classifications to the same cohort
Variables | Total (n = 1600) | ICC | WIND |
---|---|---|---|
Excluded (n = 865) | Group NW (n = 580) | ||
Age, years | 65 (54–72) | 63 (54–72) | 63 (52–71) |
Sex, male | 1088 (68.0) | 580 (67.1) | 387 (66.7) |
Underlying disease | |||
Malignancy | 952 (59.5) | 561 (64.9) | 389 (67.1) |
Respiratory | 458 (28.6) | 250 (28.9) | 156 (26.9) |
Neurologic | 225 (14.1) | 122 (14.1) | 60 (10.3) |
Gastrointestinal | 209 (13.1) | 135 (15.6) | 108 (18.6) |
Cardiovascular | 202 (12.6) | 99 (11.4) | 65 (11.2) |
Genitourinary | 171 (10.7) | 70 (8.1) | 48 (8.3) |
Interval between hospital admission and ICU admission, days | 2 (0–11) | 3 (0–14) | 3 (0–14) |
Cause of respiratory failure | |||
Pneumonia | 535 (33.4) | 270 (31.2) | 165 (28.4) |
Extrapulmonary sepsis | 345 (21.6) | 201 (23.2) | 165 (28.4) |
ARDS | 157 (9.8) | 93 (10.8) | 66 (11.4) |
CPR | 114 (7.1) | 73 (8.4) | 55 (9.5) |
Coma | 88 (5.5) | 51 (5.9) | 29 (5.0) |
Pulmonary edema | 76 (4.8) | 20 (2.3) | 15 (2.6) |
Ventilatory failure | 63 (3.9) | 24 (2.8) | 12 (2.1) |
Central airway obstruction | 55 (3.4) | 36 (4.2) | 11 (1.9) |
Exacerbation of ILD | 35 (2.2) | 18 (2.1) | 14 (2.4) |
Others | 132 (8.3) | 79 (9.1) | 48 (8.3) |
SAPS III on ICU admission | 64 (53–77) | 66 (55–79) | 68 (58–83) |
SOFA score on ICU admission | 9 (6–13) | 11 (8–14) | 12 (8–15) |
Interval between hospital admission and intubation, days | 2 (0–12) | 4 (0–16) | 4 (0–16) |
Comparison of baseline characteristics among groups according to ICC and WIND classifications
ICC | Simple | Difficult | Prolonged | Not classified | Total | Agreement, % |
---|---|---|---|---|---|---|
WIND | ||||||
Group NW | 0 | 0 | 0 | 580 | 580 | NA |
Group 1 | 462 | 46 | 0 | 109 | 617 | 74.9 |
Group 2 | 21 | 86 | 11 | 68 | 186 | 46.2 |
Group 3 | 20 | 13 | 76 | 108 | 217 | 35.0 |
Total | 503 | 145 | 87 | 865 | 1600 | |
Agreement, % | 91.8 | 59.3 | 87.4 | NA | 39.0 |
Variables | ICC classification | WIND classification | ||||||
---|---|---|---|---|---|---|---|---|
Simple (n = 503) | Difficult (n = 145) | Prolonged (n = 87) | P for trend | Group 1 (n = 617) | Group 2 (n = 186) | Group 3 (n = 217) | P for trend | |
Age, years | 65 (53–72) | 68 (55–75) | 67 (55–75) | 0.081 | 65 (54–73) | 66 (56–74) | 66 (54–73) | 0.774 |
Sex, male | 351 (69.8) | 93 (64.1) | 64 (73.6) | 0.952 | 427 (69.2) | 127 (68.3) | 147 (67.7) | 0.673 |
Underlying disease | ||||||||
Malignancy | 249 (49.5) | 81 (55.9) | 61 (70.1) | < 0.001 | 296 (48.0) | 116 (62.4) | 151 (69.6) | < 0.001 |
Respiratory | 135 (26.8) | 42 (29.0) | 31 (35.6) | 0.106 | 163 (26.4) | 57 (30.6) | 82 (37.8) | 0.002 |
Neurologic | 62 (12.3) | 24 (16.6) | 17 (19.5) | 0.042 | 94 (15.2) | 35 (18.8) | 36 (16.6) | 0.484 |
Gastrointestinal | 54 (10.7) | 17 (11.7) | 3 (3.4) | 0.108 | 68 (11.0) | 20 (10.8) | 13 (6.0) | 0.048 |
Cardiovascular | 76 (15.1) | 17 (11.7) | 10 (11.5) | 0.239 | 92 (14.9) | 21 (11.3) | 24 (11.1) | 0.108 |
Genitourinary | 74 (14.7) | 17 (11.7) | 10 (11.5) | 0.292 | 90 (14.6) | 12 (6.5) | 21 (9.7) | 0.014 |
Interval between hospital admission and ICU admission, days | 1 (0–6) | 1 (0–7) | 3 (1–11) | 0.001 | 1 (0–7) | 2 (0–8) | 3 (1–14) | < 0.001 |
Cause of respiratory failure | ||||||||
Pneumonia | 170 (33.8) | 49 (33.8) | 46 (52.9) | 0.004 | 211 (34.2) | 62 (33.3) | 97 (44.7) | 0.013 |
Extrapulmonary sepsis | 104 (20.7) | 30 (20.7) | 10 (11.5) | 0.095 | 111 (18.0) | 38 (20.4) | 31 (14.3) | 0.343 |
ARDS | 40 (8.0) | 15 (10.3) | 9 (10.3) | 0.326 | 50 (8.1) | 14 (7.5) | 27 (12.4) | 0.087 |
CPR | 31 (6.2) | 8 (5.5) | 2 (2.3) | 0.204 | 39 (6.3) | 11 (5.9) | 9 (4.1) | 0.259 |
Coma | 23 (4.6) | 8 (5.5) | 6 (6.9) | 0.396 | 35 (5.7) | 10 (5.4) | 14 (6.5) | 0.725 |
Pulmonary edema | 45 (8.9) | 10 (6.9) | 1 (1.1) | 0.014 | 48 (7.8) | 9 (4.8) | 4 (1.8) | 0.001 |
Ventilatory failure | 28 (5.6) | 9 (6.2) | 2 (2.3) | 0.409 | 34 (5.5) | 11 (5.9) | 6 (2.8) | 0.159 |
Central airway obstruction | 14 (2.8) | 2 (1.4) | 3 (3.4) | 1.000 | 30 (4.9) | 9 (4.8) | 5 (2.3) | 0.143 |
Exacerbation of ILD | 12 (2.4) | 3 (2.1) | 2 (2.3) | 1.000 | 13 (2.1) | 4 (2.2) | 4 (1.8) | 0.894 |
Others | 36 (7.2) | 11 (7.6) | 6 (6.9) | 1.000 | 46 (7.5) | 18 (9.7) | 20 (9.2) | 0.332 |
SAPS III on ICU admission | 61 (50–73) | 63 (54–76) | 64 (53–77) | 0.046 | 61 (50–73) | 63 (54–76) | 65 (55–76) | 0.001 |
SOFA score on ICU admission | 8 (5–11) | 8 (5–11) | 8 (5–11) | 0.514 | 8 (5–11) | 8 (5–11) | 9 (5–12) | 0.063 |
Interval between hospital admission and intubation, days | 1 (0–8) | 2 (0–8) | 3 (1–14) | < 0.001 | 1 (0–8) | 3 (1–10) | 4 (1–16) | < 0.001 |
Clinical outcomes among groups according to ICC and WIND classifications
Variables | Total (n = 1600) | ICC | WIND |
---|---|---|---|
Excluded (n = 865) | Group NW (n = 580) | ||
Interval between intubation and the first SA, daysa | 3 (2–6) | 4 (2–10) | – |
SOFA score at the day of first SAa | 5 (3–8) | 7 (5–9) | – |
MV days | 5 (2–11) | 6 (2–15) | 5 (2–11) |
Ventilator-free daysb | 2 (0–24) | 0 (0–0) | 0 |
Tracheostomy | 436 (27.3) | 277 (32.0) | 101 (17.4) |
No | 1164 (72.8) | 568 (65.7) | 479 (82.6) |
Before MV | 20 (1.3) | 20 (2.3) | 6 (1.0) |
Between MV and first SA | 219 (13.7) | 219 (25.3) | 95 (16.4) |
Between first SA and extubation | 151 (9.4) | 54 (6.2) | – |
After the first extubation | 46 (2.9) | 4 (0.5) | – |
Interval between intubation and tracheostomy, daysc | 11 (6–15) | 9 (5–14) | 10 (7–14) |
Successful weaning from MVd | 824 (51.5) | 160 (18.5) | 0 |
ICU mortality | 656 (41.0) | 588 (68.0) | 511 (88.1) |
LOS in ICU, days | 7 (4–15) | 8 (3–17) | 6 (2–13) |
Hospital mortality | 848 (53.0) | 643 (74.3) | 520 (89.7) |
LOS in hospital, days | 24 (13–46) | 20 (9–43) | 15 (5–30) |
Type of discharge | |||
Home | 422 (26.4) | 44 (5.1) | 0 |
Other hospital | 219 (13.7) | 90 (10.4) | 5 (0.9) |
Other ICU | 24 (1.5) | 20 (2.3) | 10 (1.7) |
Hospice | 87 (5.4) | 68 (7.9) | 45 (7.8) |
Death | 848 (53.0) | 643 (74.3) | 520 (89.7) |
Variables | ICC classification | WIND classification | ||||||
---|---|---|---|---|---|---|---|---|
Simple (n = 503) | Difficult (n = 145) | Prolonged (n = 87) | P for trend | Group 1 (n = 617) | Group 2 (n = 186) | Group 3 (n = 217) | P for trend | |
Interval between intubation and the first SA, days | 3 (2–5) | 3 (2–6) | 4 (2–7) | 0.002 | 3 (2–5) | 3 (2–6) | 4 (2–9) | < 0.001 |
SOFA score at the day of first SA | 5 (3–7) | 6 (3–8) | 5 (4–8) | < 0.001 | 5 (3–7) | 6 (4–8) | 7 (5–9) | < 0.001 |
MV days | 3 (2–6) | 7 (4–10) | 19 (12–28) | < 0.001 | 3 (2–5) | 7 (5–10) | 21 (14–35) | < 0.001 |
Ventilator-free daysa | 25 (22–26) | 21 (18–24) | 0 (0–13) | < 0.001 | 25 (23–26) | 19 (0–23) | 0 (0–5) | < 0.001 |
Tracheostomy | 40 (8.0) | 37 (25.5) | 62 (71.3) | < 0.001 | 109 (17.7) | 64 (34.4) | 162 (74.7) | < 0.001 |
No | 463 (92.0) | 108 (74.5) | 25 (28.7) | – | 508 (82.3) | 122 (65.6) | 55 (25.3) | – |
Before MV | – | – | – | – | 10 (1.6) | 3 (1.6) | 1 (0.5) | – |
Between MV and first SA | – | – | – | – | 63 (10.2) | 21 (11.3) | 40 (18.4) | – |
Between first SA and extubation | 12 (2.4) | 25 (17.2) | 60 (69.0) | – | 0 | 32 (17.2) | 119 (54.8) | – |
After the first extubation | 28 (5.6) | 12 (8.3) | 2 (2.3) | – | 36 (5.8) | 8 (4.3) | 2 (0.9) | – |
Interval between intubation and tracheostomy, daysb | 18 (13–33) | 12 (5–19) | 11 (9–15) | < 0.001 | 10 (2–17) | 7 (4–12) | 12 (9–15) | < 0.001 |
Successful weaning from MVc | 486 (96.6) | 138 (95.2) | 40 (46.0) | < 0.001 | 608 (98.5) | 143 (76.9) | 73 (33.6) | < 0.001 |
ICU mortality | 27 (5.4) | 8 (5.5) | 33 (37.9) | < 0.001 | 22 (3.6) | 31 (16.7) | 92 (42.4) | < 0.001 |
LOS in ICU, days | 6 (3–9) | 10 (6–14) | 21 (14–30) | < 0.001 | 6 (4–9) | 10 (7–14) | 24 (17–35) | < 0.001 |
Hospital mortality | 113 (22.5) | 37 (25.5) | 55 (63.2) | < 0.001 | 131 (21.2) | 63 (33.9) | 134 (61.8) | < 0.001 |
LOS in hospital, days | 24 (14–45) | 31 (19–57) | 40 (27–74) | < 0.001 | 25 (15–51) | 29 (16–52) | 45 (29–78) | < 0.001 |
Type of discharge | ||||||||
Home | 296 (58.8) | 72 (49.7) | 10 (11.5) | – | 343 (55.6) | 62 (33.3) | 17 (7.8) | – |
Other hospital | 82 (16.3) | 30 (20.7) | 17 (19.5) | – | 129 (20.9) | 45 (24.2) | 40 (18.4) | – |
Other ICU | 0 | 1 (0.7) | 3 (3.4) | – | 0 | 4 (2.2) | 10 (4.6) | – |
Hospice | 12 (2.4) | 5 (3.4) | 2 (2.3) | – | 14 (2.3) | 12 (6.5) | 16 (7.4) | – |
Death | 113 (22.5) | 37 (25.5) | 55 (63.2) | – | 131 (21.2) | 63 (33.9) | 134 (61.8) | – |