Terminal weaning from mechanical ventilation in critically ill patients with or without severe brain damage

Introduction

The withdrawal of mechanical ventilation as a terminal care process occurs with increasing frequency. The aim of the study was to evaluate patients undergoing terminal weaning (TW) with or without severe brain damage.

Methods

A prospective, descriptive study of all patients experienced TW during 2 years period was conducted. Apache II, SOFA, length of ICU stay (days) before decision of TW (LOS), method (step-wise reduction or withdrawal of ventilatory support), using analgesia/sedation during TW procedure and length of TW (LTW) in minutes were recorded. Data as mean (SD), median (25-75%), t-test, Mann-Whitney Rank Sum Test (SigmaStat Statistical Software) were used, P < 0.05 was considered statistically significant.

Results

Sixteen patients were studied, Apache II and SOFA score were 32 (6.9) resp. 12.9 (3.7). Eleven patients with severe brain damage (group BD), five patients without brain damage (group NBD). All patients died during TW. The LOS was shorter in BD group comparing to NBD group, 2.9 (1.9) resp. 17 (9.3), P < 0.0001. The TW procedure was step-wise reduction of ventilatory support in 5 patients and as a ventilator withdrawal in 11 patients. The length of TW was 17 (12-87) in BD group and 187 (16-605) in NBD group. Analgesia/sedation was employed in eight patients, there were no statistically significant differences in LTW between patients with or without analgesia/sedation (223, 13-662, resp. 15, 12-43, P = 0.232).

Discussion

LOS before decision of TW was significantly longer in patients without brain damage. There were no significant differences in length of TW as between groups BD and NBD as between patients with or without analgesia.

Supported by IGA MZ CR 4530-3.