Hommelsheim, Catharina and Sichau, Mathias and Heipel, Roland and Mueller, Eckhard and Gatermann, Soeren and Pfeifer, Michael and Ewig, Santiago (2019) Predictors of Outcomes in Patients with Prolonged Weaning with Focus on Respiratory Tract Pathogens and Infection. RESPIRATION, 97 (2). pp. 135-144. ISSN 0025-7931, 1423-0356
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Background: The impact of respiratory tract pathogens and infection on outcomes in patients with prolonged weaning is largely unknown. Objective: We studied predictors of weaning outcomes (death and failure to achieve spontaneous ventilation) in a population treated during a 3.5-year period in a specialized and certified weaning centre. Methods: Patient data were retrieved retrospectively from the clinical charts. Complete datasets were available in 173 patients. The following parameters were investigated as potential predictors of both endpoints: age; comorbidities; tracheobronchial pathogens; bacteraemia, pneumonia and number of pneumonias; and number of inhouse treatment cycles (none vs. >= 1). Results: Tracheobronchial pathogens, pneumonia, bacteraemia and the number of antibiotic cycles all significantly increased weaning duration and hospitalisation times. Independent predictors of death were atrial fibrillation (OR 2.6, 95% CI 1.2-5.8, p = 0.02) and tracheobronchial multiresistant Pseudomonas aeruginosa (OR 3.9, 95% CI 1.4-11.0, p = 0.01). Independent predictors of failure to achieve spontaneous ventilation included chronic obstructive pulmonary disease (OR 2.8, 95% CI 1.0-7.8, p = 0.045); neuromuscular disease (OR 8.3, 95% CI 1.2-27.2, p = 0.02); tracheobronchial P. aeruginosa (OR 3.3, 95% CI 1.3-9.3, p = 0.01); Stenotrophomonas maltophilia (OR 7.9, 95% CI 1.4-51.6, p = 0.02); and pneumonia (OR 4.4, 95% CI 1.5-10.9, p = 0.003). Conclusions: The impact of respiratory tract pathogens and infection on weaning outcomes was remarkable. Predictors of death and failure to achieve spontaneous ventilation differed considerably. A priority may be to investigate preventive strategies against colonisation and infection with respiratory pathogens, particularly P. aeruginosa. (C) 2018 S. Karger AG, Basel
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | VENTILATOR-ASSOCIATED PNEUMONIA; PSEUDOMONAS-AERUGINOSA; FUNCTIONAL DISABILITY; RISK-FACTORS; COLONIZATION; HOSPITALIZATION; ACQUISITION; RESISTANCE; THERAPY; ILLNESS; Respiratory tract; Pathogens; Respiratory infection; Pneumonia; Bacteremia |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 22 Apr 2020 05:31 |
| Last Modified: | 22 Apr 2020 05:31 |
| URI: | https://pred.uni-regensburg.de/id/eprint/27851 |
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