The outcomes and predictors associated with prolonged weaning of postoperative patients requiring mechanical ventilation in general wards

Background & Objective: Many of the postoperative patients may require ventilatory management. In a resource-limited country, not all of them may find a place in intensive care units (ICUs), and may need to be ventilated in general wards till they are weaned off or shifted to ICU. Our primary objective was to describe weaning outcomes of such patients in the general wards, and the secondary objective was to assess predictors associated with prolonged weaning in these patients. Methodology: This retrospective study was conducted in a tertiary care hospital in Thailand. From January 2014 to December 2019, we identified 553 patients who received postoperative mechanical ventilation in general wards after non-cardiac surgeries. The weaning characteristics and the factors associated with prolonged ventilation and weaning were recorded. Results: Incidence of short (<= 24 h), difficult (> 1, but <= 7 days), prolonged (> 7 days) and no weaning were 53.0%, 28.6%, 15.0% and 3.4%, respectively. The predictors of prolonged weaning were postoperative Glasgow Coma Scale <= 8 [adjusted odds ratio (OR) 11.34, 95% confidence interval (CI) 5.05-25.47], repeated surgeries (OR 7.38, 95% CI 3.67-14.83), totally dependent functional status (OR 3.22, 95% CI 1.35-7.72), and age more than 65 y (OR 2.35 95% CI 1.29-4.25). Reintubation rate was 5.1%. Accidental extubation rate was 2.3%. Incidence of ventilator associated pneumonia was 11.6%. The 30-day mortality rate was 6%. Conclusion: Weaning processes in general wards were mostly terminated within 24 h; however, 15% of patients experienced prolonged weaning. Postoperative Glasgow Coma Scale <= 8, repeated surgeries, totally dependent functional status, and age more than 65 y were the predictors of prolonged weaning.