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Factors affecting the success of weaning in patients with chronic obstructive pulmonary disease

Year 2011, Volume: 38 Issue: 3, 263 - 273, 01.09.2011
https://doi.org/10.5798/diclemedj.0921.2011.03.0029

Abstract

Objectives: Weaning failure rate was higher in patients with chronic obstructive pulmonary disease (COPD) and many factors affect it. The aim of this study was to in­vestigate the factors affecting the success of weaning in COPD patients receiving invasive mechanical ventilation (IMV). Materials and methods: Totally 43 COPD patients who received IMV in intensive care unit were included. Clinical and laboratory results and Acute Physiology Assessment and Chronic Health Evaluation (APACHE II) scores were recorded and affecting factors on weaning success were investigated. Results: In 43 patients, 25 had successful weaning (58.1%). Patients with high APACHE II score prior to intu­bation was found as associated with weaning failure. High Glasgow coma scale (GCS) scores before entubation and weaning are associated with weaning success. Pre-weaning anxiety, positive endotracheal aspirate culture, pulmonary arterial pressure value, enteral feeding, pre-weaning tachycardia, pre-weaning cuff leaking and FiO2 values were found to be associated with weaning failure. Pre-weaning cortisol levels were associated with wean­ing success. In successful weaning group, measured NIF and VT in spontaneous mode were found as higher and f/VT ratio was lower compared with unsuccessful group. T-tube during the 15th and 30th minutes of the symptoms of fatigue (sweating assets) were associated with wean­ing failure. IMV duration and longer extubation duration of weaning, and more number of t-tube insertion attempts were found as associated with failure of weaning. Conclusions: Infection in patients with COPD, the pres­ence of anxiety, and hemodynamic and respiratory insta­bility significantly increases the weaning failure.

References

  • Celli BR, MacNee W, Agusti A, et al. ATS/ ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ ERS position paper. Eur Respir J 2004;23(6):932-46.
  • Ferrer M, Esquinas A, Arancibia F, et al. Noninvasive venti- lation during persistent weaning failure: a randomized, con- trolled trial. Am J Respir Crit Care Med 2003;168(1):70-6.
  • Tobin MJ. Principles and Practice of Mechanical Ventilation, McGraw Hill inc. 2006:63-8.
  • Esteban A, Alia I, Ibanez J, et al. Modes of mechanical ven- tilation and weaning. A national survey of Spanish hospi- tals. The Spanish Lung Failure Collaborative Group. Chest 1994;106(4):1188-93.
  • MacIntyre NR, Cook DJ, Ely EW. Evidence Based Guide- lines for Weaning and discontinuing ventilatory support. Chest 2001;120(6 Suppl):S375-95.
  • Bacakoğlu F. Sık Kullanılan Ventilasyon Modları. In: Solu- num Desteği Gereken Hastalarda Mekanik Ventilasyon Uy- gulamaları. Uçgun İ (Ed). ASD Toraks Yayınları 2005:42- 52.
  • Nava S, Rubini F, Zanotti E. Survival and prediction of suc- cessful ventilator weaning in COPD patients requiring me- chanical ventilation for more than 21 days. Eur Respir J 1994;7(9):1645-52.
  • Yang P-H, Hung J-Y, Yang C-J. Successful weaning predic- tors in a respiratory care center in Taiwan. Kaohsiung J Med Sci 2008;24(2):85-91.
  • Scheinhorn DJ, Hassenpflug M, Artinian BM, LaBree L. Pre- dictors of weaning after 6 weeks of mechanical ventilation. Chest 1995;107(2):500-5.
  • Epstein SK, Ciubotaru RL. Influence of gender and endo- tracheal tube size on preextubation breathing pattern. Am J Respir Crit Care Med 1996;154(6):1647-52.
  • Knaus WA, Draper EA, Wagner DP, et al. APACHE II: A severity of disease classification system. Crit Care Med. 1985;13(10):818-29.
  • Schönhofer B, Guo JJ. The use of APACHE II prognostic system in difficult to wean patients after long term mechan- ical ventilation. Eur J Anaesth 2004;21(7):558-65.
  • Amoateng-Adjepong Y, Jacob BK, Ahmad M, Manthous CA. The effect of sepsis on breathing pattern and weaning outcomes in patients recovering from respiratory failure. Chest 1997;112(2):472-7.
  • Menzies R, Gibbons W, Goldberg P. Determinants of wean- ing and survival among patients with COPD who require mechanical ventilation for acute respiratory failure. Chest 1989;95(2):398-405.
  • Nozawa E, Azeka E, Ignêz M, et al. Factors associated with failure of weaning from long-term mechanical ventilation after cardiac surgery. Int Heart J 2005;46(5):819-31.
  • Navalesi P, Frigero P, Moretti MP, et al. Rate of reintubation in mechanically ventilated neurosurgical and neurologic patients: Evaluation of a systemic approach to weaning and extubation. Crit Care Med 2008;36(11):2986-92.
  • Khamiees M, Raju P, DeGirolamo A, et al. Predictors of extubation outcome in patients who have success- fully completed a spontaneous breathing trial. Chest 2001;120(4):1262-70.
  • Clochesy JM, Daly BJ, Montenegro HD. Weaning chroni- cally critically ill adults from mechanical ventilatory sup- port: a descriptive study. Am J Crit Care 1995;4(2):93-9.
  • Krinsley JS. Association between hyperglycemia and in- creased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc 2003;78(12):1471-8.
  • Van den Berghe G, Wouters P, Weekers F. Intensive in- sulin therapy in critically ill patients. N Engl J Med 2001;345(19):1359-67.
  • Chatila W, Ani S, Guaglianone D, et al. Cardiac isch- emia during weaning from mechanical ventilation. Chest 1996;109(6):1577-83.
  • Lemaire F, Teboul JL, Cinotti L, et al. Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 1988;69(2):171-9.
  • Kahramanoğlu M, Yaşar MA, Demirel İ, ve ark. Wean- ing başarısızlığının göstergesi olarak yüksek serum CRP düzeyi. Fırat Tıp Dergisi 2007;12(2):115-7.
  • Robriquet L, Georges H, Leroy O, et al. Predictors of ex- tubation failure in patients with chronic obstructive pulmo- nary disease. Journal of Critical Care 2006;21(2):185-92.
  • Çelikel T, Topeli İskit A. Mekanik ventilasyonun sonlandırılması (weaning). Yoğun Bakım Dergisi 2004;4(4):205-10.
  • Chlan LL. Description of anxiety levels by individual dif- ferences and clinical factors in patients receiving mechani- cal ventilatory support. Heart Lung 2003;32(4):275-82.
  • Yang KL, Tobin MJ. A prospective study of indexes pre- dicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991;324(21):1445-50.
  • Sassoon CSH, Mahutte CK. Airway occlusion pressure and breathing pattern as predictors of weaning outcome. Am Rev Respir Dis 1993;148(4):860-6.
  • Vallverdu I, Calaf N, Subirana M, Net A, Benito S, Man- cebo J. Clinical characteristics, respiratory functional pa- rameters, and outcome of a two-hour T-piece trial in pa- tients weaning from mechanical ventilation. Am J Respir Crit Care Med 1998;158(6):1855–62.
  • Alvisi R, Volta CA, Righini ER, et al. Predictors of weaning outcome in chronic obstructive pulmonary disease patients. Eur Respir J 2000;15(4):656-2.

Kronik obstrüktif akciğer hastalığı bulunan hastalarda mekanik ventilatörden ayırma başarısını etkileyen faktörler

Year 2011, Volume: 38 Issue: 3, 263 - 273, 01.09.2011
https://doi.org/10.5798/diclemedj.0921.2011.03.0029

Abstract

Amaç: Kronik obstrüktif akciğer hastalığı (KOAH) bulunan hastalarda ventilatörden ayırma başarısızlığı oranı yüksek olup, bunu etkileyen birçok faktör bulunmaktadır. Bu çalış­manın amacı invaziv mekanik ventilasyon (İMV) uygulanan KOAH hastalarında mekanik ventilatörden ayırma başarısını etkileyen faktörleri incelemektir. Gereç ve yöntem: Çalışmaya yoğun bakımımızda İMV uy­gulanan 43 KOAH hastası dahil edildi. Hastaların klinik ve laboratuar bulguları ve Akut Fizyoloji ve Kronik Sağlık Değer­lendirmesi (APACHE II) skorları kaydedildi ve mekanik venti­latörden ayırma başarısını etkileyen faktörler araştırıldı. Bulgular: Toplam 43 hastanın 25\'inde mekanik ventilatörden ayırma başarılı olarak gerçekleştirildi (%58.1). Hastaların entübasyon öncesi APACHE II skoru yüksekliği ile mekanik ventilatörden ayırma başarısızlığı arasında anlamlı ilişki bu­lundu. Entübasyon ve mekanik ventilatörden ayırma öncesi Glasgow koma skalasının yüksek olması ayırma başarısı ile ilişkili bulundu. Mekanik ventilatörden ayırma öncesi anksi­yete varlığı, endotrakeal aspiratta üreme, yüksek pulmoner arter basıncı değeri, enteral beslenme, taşikardi varlığı, kaf kaçağı miktarı ve FiO2 değeri ile ayırma başarısızlığı arasın­da anlamlı ilişki vardı. Hastalarda mekanik ventilatörden ayır­ma öncesi kortizol seviyesi ile mekanik ventilatörden ayırma başarısı ilişkili bulundu. Spontan modda ölçülen negatif inspi­ratuar kuvvet (NIF) ve tidal volüm (VT) mekanik ventilatörden ayırmanın başarılı olduğu grupta daha yüksek, f/VT oranı ise daha düşük bulundu. T-tüp sırasında 15. ve 30. dakikalarda yorgunluk belirtilerinin olması ile mekanik ventilatörden ayır­ma başarısızlığı ilişkili bulundu. Hastalara uygulanan İMV süresi ve ekstübe edilebilen hastalarda mekanik ventilatör­den ayırma süresinin uzun olması ve t-tüp deneme sayısının fazla olması ile mekanik ventilatörden ayırma başarısızlığı ilişkili saptandı. Sonuç: Sonuç olarak KOAH hastalarında enfeksiyon, anksi­yete varlığı, hemodinamik ve solunumsal instabilite durumu mekanik ventilatörden ayırma başarısızlığını anlamlı olarak artırmaktadır.

References

  • Celli BR, MacNee W, Agusti A, et al. ATS/ ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ ERS position paper. Eur Respir J 2004;23(6):932-46.
  • Ferrer M, Esquinas A, Arancibia F, et al. Noninvasive venti- lation during persistent weaning failure: a randomized, con- trolled trial. Am J Respir Crit Care Med 2003;168(1):70-6.
  • Tobin MJ. Principles and Practice of Mechanical Ventilation, McGraw Hill inc. 2006:63-8.
  • Esteban A, Alia I, Ibanez J, et al. Modes of mechanical ven- tilation and weaning. A national survey of Spanish hospi- tals. The Spanish Lung Failure Collaborative Group. Chest 1994;106(4):1188-93.
  • MacIntyre NR, Cook DJ, Ely EW. Evidence Based Guide- lines for Weaning and discontinuing ventilatory support. Chest 2001;120(6 Suppl):S375-95.
  • Bacakoğlu F. Sık Kullanılan Ventilasyon Modları. In: Solu- num Desteği Gereken Hastalarda Mekanik Ventilasyon Uy- gulamaları. Uçgun İ (Ed). ASD Toraks Yayınları 2005:42- 52.
  • Nava S, Rubini F, Zanotti E. Survival and prediction of suc- cessful ventilator weaning in COPD patients requiring me- chanical ventilation for more than 21 days. Eur Respir J 1994;7(9):1645-52.
  • Yang P-H, Hung J-Y, Yang C-J. Successful weaning predic- tors in a respiratory care center in Taiwan. Kaohsiung J Med Sci 2008;24(2):85-91.
  • Scheinhorn DJ, Hassenpflug M, Artinian BM, LaBree L. Pre- dictors of weaning after 6 weeks of mechanical ventilation. Chest 1995;107(2):500-5.
  • Epstein SK, Ciubotaru RL. Influence of gender and endo- tracheal tube size on preextubation breathing pattern. Am J Respir Crit Care Med 1996;154(6):1647-52.
  • Knaus WA, Draper EA, Wagner DP, et al. APACHE II: A severity of disease classification system. Crit Care Med. 1985;13(10):818-29.
  • Schönhofer B, Guo JJ. The use of APACHE II prognostic system in difficult to wean patients after long term mechan- ical ventilation. Eur J Anaesth 2004;21(7):558-65.
  • Amoateng-Adjepong Y, Jacob BK, Ahmad M, Manthous CA. The effect of sepsis on breathing pattern and weaning outcomes in patients recovering from respiratory failure. Chest 1997;112(2):472-7.
  • Menzies R, Gibbons W, Goldberg P. Determinants of wean- ing and survival among patients with COPD who require mechanical ventilation for acute respiratory failure. Chest 1989;95(2):398-405.
  • Nozawa E, Azeka E, Ignêz M, et al. Factors associated with failure of weaning from long-term mechanical ventilation after cardiac surgery. Int Heart J 2005;46(5):819-31.
  • Navalesi P, Frigero P, Moretti MP, et al. Rate of reintubation in mechanically ventilated neurosurgical and neurologic patients: Evaluation of a systemic approach to weaning and extubation. Crit Care Med 2008;36(11):2986-92.
  • Khamiees M, Raju P, DeGirolamo A, et al. Predictors of extubation outcome in patients who have success- fully completed a spontaneous breathing trial. Chest 2001;120(4):1262-70.
  • Clochesy JM, Daly BJ, Montenegro HD. Weaning chroni- cally critically ill adults from mechanical ventilatory sup- port: a descriptive study. Am J Crit Care 1995;4(2):93-9.
  • Krinsley JS. Association between hyperglycemia and in- creased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc 2003;78(12):1471-8.
  • Van den Berghe G, Wouters P, Weekers F. Intensive in- sulin therapy in critically ill patients. N Engl J Med 2001;345(19):1359-67.
  • Chatila W, Ani S, Guaglianone D, et al. Cardiac isch- emia during weaning from mechanical ventilation. Chest 1996;109(6):1577-83.
  • Lemaire F, Teboul JL, Cinotti L, et al. Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 1988;69(2):171-9.
  • Kahramanoğlu M, Yaşar MA, Demirel İ, ve ark. Wean- ing başarısızlığının göstergesi olarak yüksek serum CRP düzeyi. Fırat Tıp Dergisi 2007;12(2):115-7.
  • Robriquet L, Georges H, Leroy O, et al. Predictors of ex- tubation failure in patients with chronic obstructive pulmo- nary disease. Journal of Critical Care 2006;21(2):185-92.
  • Çelikel T, Topeli İskit A. Mekanik ventilasyonun sonlandırılması (weaning). Yoğun Bakım Dergisi 2004;4(4):205-10.
  • Chlan LL. Description of anxiety levels by individual dif- ferences and clinical factors in patients receiving mechani- cal ventilatory support. Heart Lung 2003;32(4):275-82.
  • Yang KL, Tobin MJ. A prospective study of indexes pre- dicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991;324(21):1445-50.
  • Sassoon CSH, Mahutte CK. Airway occlusion pressure and breathing pattern as predictors of weaning outcome. Am Rev Respir Dis 1993;148(4):860-6.
  • Vallverdu I, Calaf N, Subirana M, Net A, Benito S, Man- cebo J. Clinical characteristics, respiratory functional pa- rameters, and outcome of a two-hour T-piece trial in pa- tients weaning from mechanical ventilation. Am J Respir Crit Care Med 1998;158(6):1855–62.
  • Alvisi R, Volta CA, Righini ER, et al. Predictors of weaning outcome in chronic obstructive pulmonary disease patients. Eur Respir J 2000;15(4):656-2.
There are 30 citations in total.

Details

Primary Language Turkish
Journal Section Research Articles
Authors

Turgut Teke This is me

Rukiye Metineren This is me

Emin Maden This is me

Kürşat Uzun This is me

Publication Date September 1, 2011
Submission Date March 2, 2015
Published in Issue Year 2011 Volume: 38 Issue: 3

Cite

APA Teke, T., Metineren, R., Maden, E., Uzun, K. (2011). Kronik obstrüktif akciğer hastalığı bulunan hastalarda mekanik ventilatörden ayırma başarısını etkileyen faktörler. Dicle Tıp Dergisi, 38(3), 263-273. https://doi.org/10.5798/diclemedj.0921.2011.03.0029
AMA Teke T, Metineren R, Maden E, Uzun K. Kronik obstrüktif akciğer hastalığı bulunan hastalarda mekanik ventilatörden ayırma başarısını etkileyen faktörler. diclemedj. September 2011;38(3):263-273. doi:10.5798/diclemedj.0921.2011.03.0029
Chicago Teke, Turgut, Rukiye Metineren, Emin Maden, and Kürşat Uzun. “Kronik obstrüktif akciğer hastalığı Bulunan Hastalarda Mekanik ventilatörden ayırma başarısını Etkileyen faktörler”. Dicle Tıp Dergisi 38, no. 3 (September 2011): 263-73. https://doi.org/10.5798/diclemedj.0921.2011.03.0029.
EndNote Teke T, Metineren R, Maden E, Uzun K (September 1, 2011) Kronik obstrüktif akciğer hastalığı bulunan hastalarda mekanik ventilatörden ayırma başarısını etkileyen faktörler. Dicle Tıp Dergisi 38 3 263–273.
IEEE T. Teke, R. Metineren, E. Maden, and K. Uzun, “Kronik obstrüktif akciğer hastalığı bulunan hastalarda mekanik ventilatörden ayırma başarısını etkileyen faktörler”, diclemedj, vol. 38, no. 3, pp. 263–273, 2011, doi: 10.5798/diclemedj.0921.2011.03.0029.
ISNAD Teke, Turgut et al. “Kronik obstrüktif akciğer hastalığı Bulunan Hastalarda Mekanik ventilatörden ayırma başarısını Etkileyen faktörler”. Dicle Tıp Dergisi 38/3 (September 2011), 263-273. https://doi.org/10.5798/diclemedj.0921.2011.03.0029.
JAMA Teke T, Metineren R, Maden E, Uzun K. Kronik obstrüktif akciğer hastalığı bulunan hastalarda mekanik ventilatörden ayırma başarısını etkileyen faktörler. diclemedj. 2011;38:263–273.
MLA Teke, Turgut et al. “Kronik obstrüktif akciğer hastalığı Bulunan Hastalarda Mekanik ventilatörden ayırma başarısını Etkileyen faktörler”. Dicle Tıp Dergisi, vol. 38, no. 3, 2011, pp. 263-7, doi:10.5798/diclemedj.0921.2011.03.0029.
Vancouver Teke T, Metineren R, Maden E, Uzun K. Kronik obstrüktif akciğer hastalığı bulunan hastalarda mekanik ventilatörden ayırma başarısını etkileyen faktörler. diclemedj. 2011;38(3):263-7.