Medicina intensiva · 2025
Association between time to weaning from mechanical ventilation and presence of physical and mental health disabilities in survivors of critical illness: a multicenter prospective cohort study.
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Valer Bruna Bampi, Teixeira Cassiano, Rosa Regis Goulart, Sganzerla Daniel, Friedman Gilberto
Аннотация
OBJECTIVE: To evaluate the association between weaning time from invasive mechanical ventilation (IMV) and occurrence of physical and mental health disabilities in ICU survivors.
DESIGN: Prospective, multicenter cohort study.
SETTING: 10 Brazilian ICUs (May 2014-December 2018).
PATIENTS OR PARTICIPANTS: Adult survivors with an ICU stay >72 h for emergency medical and surgical admissions or >120 h for elective surgical admissions and who used IMV. Classification into 3 groups: simple, difficult, and prolonged weaning.
INTERVENTIONS: Follow-up through structured telephone interviews MAIN VARIABLES OF INTEREST: Outcomes included moderate to severe functional physical dependence (Barthel Index score ≤75) at 3 months post-ICU discharge, symptoms of anxiety and depression (Hospital Anxiety and Depression Symptom Scale scores >7 in the anxiety or depression subdomains) and post-traumatic stress (Impact Event Scale-6 > 9) at 6 months post-ICU discharge and all-cause post-ICU mortality (categorized as early [0-30 days] and late [>30 days]).
RESULTS: Of the 804 patients, 492 (61.2%) presented simple weaning, 60 (7.5%) difficult weaning and 252 (31.3%) prolonged weaning. In total, 670 (83.3%) and 630 (78.3%) patients were alive at 3 and 6 months. Early post-ICU mortality (13.1% vs. 7.1%; p = 0.01) and 3-month physical dependence (55.9% vs. 37.6%; p < 0.001) were both higher in the prolonged weaning group than in the simple weaning group. At 6 months, difficult weaning patients were more anxious (55% vs 23.6% vs 21.4%; p = 0.02) and depressed (50% vs 24.7% vs 17.1%; p = 0.04) compared to simple and prolonged weaning groups, respectively, with no differences regarding post-traumatic stress.
CONCLUSION: ICU survivors who experienced prolonged weaning had higher early post-ICU mortality and greater rates of moderate to severe physical functional dependence at three months after discharge, whereas those with difficult weaning showed higher rates of anxiety and depression at six months.
DESIGN: Prospective, multicenter cohort study.
SETTING: 10 Brazilian ICUs (May 2014-December 2018).
PATIENTS OR PARTICIPANTS: Adult survivors with an ICU stay >72 h for emergency medical and surgical admissions or >120 h for elective surgical admissions and who used IMV. Classification into 3 groups: simple, difficult, and prolonged weaning.
INTERVENTIONS: Follow-up through structured telephone interviews MAIN VARIABLES OF INTEREST: Outcomes included moderate to severe functional physical dependence (Barthel Index score ≤75) at 3 months post-ICU discharge, symptoms of anxiety and depression (Hospital Anxiety and Depression Symptom Scale scores >7 in the anxiety or depression subdomains) and post-traumatic stress (Impact Event Scale-6 > 9) at 6 months post-ICU discharge and all-cause post-ICU mortality (categorized as early [0-30 days] and late [>30 days]).
RESULTS: Of the 804 patients, 492 (61.2%) presented simple weaning, 60 (7.5%) difficult weaning and 252 (31.3%) prolonged weaning. In total, 670 (83.3%) and 630 (78.3%) patients were alive at 3 and 6 months. Early post-ICU mortality (13.1% vs. 7.1%; p = 0.01) and 3-month physical dependence (55.9% vs. 37.6%; p < 0.001) were both higher in the prolonged weaning group than in the simple weaning group. At 6 months, difficult weaning patients were more anxious (55% vs 23.6% vs 21.4%; p = 0.02) and depressed (50% vs 24.7% vs 17.1%; p = 0.04) compared to simple and prolonged weaning groups, respectively, with no differences regarding post-traumatic stress.
CONCLUSION: ICU survivors who experienced prolonged weaning had higher early post-ICU mortality and greater rates of moderate to severe physical functional dependence at three months after discharge, whereas those with difficult weaning showed higher rates of anxiety and depression at six months.