Prolonged Weaning Takes its Toll
Patients on mechanical ventilation who take longer to wean after meeting eligibility requirements for weaning have worse outcomes, report researchers publishing in The Lancet Respiratory Medicine.
The WEAN SAFE study was conducted in 481 ICUs around the world and involved 5,869 patients over the age of 16 who had received mechanical ventilation for at least two days. The primary outcome measure was the number of successfully weaned patients at 90 days, defined as no reintubation or death within seven days of extubation.
Only 3,817 of the patients in the study, or 65%, were successfully weaned by 90 days.
Death in the ICU occurred in 1,742 patients, or 31.8%. Among that group 63.7% died before they could undergo a weaning attempt, 31.7% died after a failed attempt, and 4.6% after weaning from ventilation. Overall, 2,095, or 38.3%, died while in the hospital, 16.8% after they had been discharged from the ICU.
Among the 4,523 patients, or 77.1%, who underwent at least one weaning attempt, the median time to weaning was one day. But 22.4% had a delay of five days or more from the time of weaning eligibility. Overall, 64.7% had a short weaning process, defined as one day, 10.1% had an intermediate weaning process, defined as two to six days, 9.6% required prolonged weaning of seven days, and 15.6% experienced weaning failure, defined as death, transfer, or continued ventilation by 90 days.
A lower risk of delayed initiation of the first weaning attempt was seen in those with cardiac arrest. A higher risk was seen in those with frailty, trauma admission, and non-trauma neurological events.
The investigators noted an independent relationship between increased sedation scores and delayed initiation of weaning as well, and both of those factors increased the odds of weaning failure. Weaning failure was additionally associated with older age, frailty, and an immunocompromised status.
“Despite the importance of the weaning process, this area is not well studied,” said study author John Laffey, MD, DSc, from the University of Galway. “Our research on this clinical practice is the largest study to date to offer data relating weaning practices to outcomes from invasive mechanical ventilation in a global cohort of patients at risk for prolonged weaning and/or weaning failure.” Read More
CPAP Treatment Improves COPD Outcomes in People with COPD/OSA Overlap
A new study suggests people with both COPD and obstructive sleep apnea (OSA) can improve their lung function and reduce the number of exacerbations they experience by adhering to treatment with CPAP for their OSA.
The investigators reached that conclusion after comparing outcomes for 59 patients with COPD/OSA overlap who were newly prescribed CPAP treatment. Among the group, 54 were male. All were followed for 12 months and divided into two groups. Group A participants were told to use their device for four or more hours a night, while those in Group B were instructed to use it for less than four hours per night.
At the 12 month follow-up, the researchers found —
- Improvements in FEV1, total lung capacity, ratio of residual volume to total lung capacity, and the six minute walk test were seen in the group A patients.
- Patients in Group A had a decrease in COPD exacerbations when compared to baseline. At 12 months, five exacerbations were noted vs. 12 previously.
- No difference in the number of exacerbations was seen in the group B patients. They experienced 15 in both time periods.
- COPD exacerbations were associated with poor CPAP compliance.
The authors note their study was small and observational in nature but believe these findings call for additional research to further explore the impact that CPAP treatment may make on COPD in those with COPD/OSA overlap. The study was published by the Clinical Respiratory Journal. Read More
OSA Linked to Lower Bone Density
People with obstructive sleep apnea (OSA) may be more prone to bone loss, report dental researchers from the University of Buffalo.
The finding comes from a study conducted among 38 adults, about half of whom had OSA and half of whom did not. All underwent cone beam computed tomography (CBCT) to measure bone density in the head and neck. After controlling for factors such as age, sex, and weight, the investigators found significantly lower bone mineral density in the people with OSA.
The authors speculate that the key characteristics of OSA — hypoxia, inflammation, oxidative stress, and shortened breathing patterns — may have a chronic negative effect on bone metabolism and bone density. They call for additional study to further explore the connection.
The study was published by the Journal of Craniomandibular and Sleep Practice. Read More
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