The Risk Factors for Weaning Failure of Mechanically Ventilated Patients With COVID-19: A Retrospective Study in National Medical Team Work

Hua Zhao; Longxiang Su; Xin Ding; Huan Chen; Hongmin Zhang; Jinglan Wang; Yun Long; Xiang Zhou; Shuyang Zhang

doi:10.3389/fmed.2021.678157

The Risk Factors for Weaning Failure of Mechanically Ventilated Patients With COVID-19: A Retrospective Study in National Medical Team Work

Front Med (Lausanne). 2021 Aug 31:8:678157. doi: 10.3389/fmed.2021.678157. eCollection 2021.

Authors

Hua Zhao¹, Longxiang Su¹, Xin Ding¹, Huan Chen¹, Hongmin Zhang¹, Jinglan Wang², Yun Long¹, Xiang Zhou¹, Shuyang Zhang³

Affiliations

¹ Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
² Department of Respiratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
³ Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.

Abstract

Purpose: This study aimed to describe the clinical and laboratory characteristics and the parameters of the respiratory mechanics of mechanically ventilated patients with confirmed COVID-19 pneumonia and to clarify the risk or protective factors for weaning failure. Methods: Patients diagnosed with COVID-19 pneumonia were selected from the special intensive care unit (ICU) of the Sino-French New City Branch of Tong Ji Hospital, Wuhan, and treated by the National Medical Team Work. They were divided into successful weaning (SW) group (N = 15) and unsuccessful weaning (USW) group (N = 18) according to the prognosis. Information of these patients was analyzed. Results: There were 33 patients included in this study. Patients in the USW group were associated with a poor outcome; the 28-day mortality rate was higher than in the SW group (86.7 vs. 16.7% p < 0.001). By comparison, we found that the initial plateau pressure (Pplat) and driving pressure (DP) of the USW group were higher and that compliance was lower than that of the SW group, but there was no difference between positive end-expiratory pressure (PEEP), partial pressure of carbon dioxide (PCO₂), and the ratio of partial pressure arterial oxygen and fraction of inspired oxygen (P/F ratio). Comparing the worst respiratory mechanics parameters of the two groups, the results of the Pplat, DP, compliance, and PEEP were the same as the initial data. The PCO₂ of the USW group was higher, while the P/F ratio was lower. A logistic regression analysis suggested that higher Pplat might be an independent risk factor and that higher compliance and lower DP might be protective factors for weaning failure of invasive mechanically ventilated patients with COVID-19 pneumonia. Conclusions: Patients with USW were associated with a poor outcome, higher Pplat might be a risk factor, and a higher compliance and a lower DP might be protective factors for the weaning failure of ventilated COVID-19 patients. Mechanical ventilation settings will affect the patient's prognosis.

Keywords: COVID-19 pneumonia; mechanical ventilation; prognosis; risk factors; weaning failure.