Journal of Critical and Intensive Care 2020 , Vol 11, Issue 1
Factors Affecting Weaning Failure in Critically-Ill Patients Undergoing Emergency Gastrointestinal Surgery
Fatma YILDIRIM 1 ,Harun KARABACAK 1 ,İsmail Oskay KAYA 1
1University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, General Surgery Intensive Care Unit, Ankara, Turkey DOI : 10.37678/dcybd.2020.2199 Aim: Mechanical ventilation (MV) is one of the most commonly used treatment modalities in critically ill patients in the intensive care unit (ICU). Prolonged MV is associated with increased morbidity and mortality, and so the prevention of unnecessary prolonged MV and reintubation due to early extubation is of great importance. Although studies to date have studied factors that are predictive of weaning success and failure, there have been very few studies to date examining critical surgical patients requiring MV in the postoperative period. The present study investigated the factors affecting weaning failure in patients undergoing emergency gastrointestinal surgery.

Material and Method: The data of patients who underwent emergency gastrointestinal surgery between August 2016 and January 2019, that required MV for longer than 48 hours postoperatively and that were followed up in the general surgery ICU, was analyzed retrospectively.

Results: Ninety-seven patients with a mean age of 71.8±14.2 years included in study, of which 63 (64.9%) were male and 34 (35.1%) were female. The mean APACHE II score was 25.2±6.7. The main primary disease was gastrointestinal malignancy in 72.1% of the patients and the most common comorbid diseases were hypertension (53.6%) and congestive heart failure (36.1%). The median duration of MV was 9 [2–56] days and the mean length of ICU stay was 18.7±12.2 days. Weaning was started at a median 2 [2-4] days after intubation. The median weaning time was 4 [4-18] days. While 71 (73.2%) of the patients were successfully weaned, 26 (26.8%) experienced weaning failure. Of these patients, 21 (21.6%) experienced simple weaning, 40 (41.2%) experienced prolonged weaning and 36 (37.1%) experienced difficult weaning. The most common causes of weaning difficulty were hypervolemia in 88 (90.7%) patients and postoperative sepsis in 21 (21.6%) patients. Patients who suffered weaning failure had higher lactate levels, a greater need for erythrocyte suspension and vasopressor administration, and a higher rate of sepsis and acute renal failure. The presence of sepsis (OR: 4.034, 95% CI: 1.995–3.450, p= 0.04) was determined as an independent risk factor for weaning failure.

Conclusion: Weaning failure and difficult weaning were found common in critically ill patients undergoing emergency gastrointestinal surgery; and sepsis was found as an independent risk factors for weaning failure. We lack sufficient data on this patient population in our country, and so our findings need to be supported by prospective studies involving larger patient series. Keywords : Gastrointestinal Surgery, Postoperative Respiratory Failure, Mechanical Ventilation, Weaning