Score for Predicting Ventilator Weaning Duration in Patients With Tracheostomies

Am J Crit Care. 2018 Nov;27(6):477-485. doi: 10.4037/ajcc2018532.


Background: Factors affecting the timing of ventilator liberation among patients requiring prolonged mechanical ventilation (≥21 consecutive days) are poorly understood. After tracheostomy placement, ventilator liberation typically involves daily reductions in ventilator support as patients regain the capacity to breathe independently.

Objectives: To determine the association between ventilator requirements on the day after tracheostomy placement and subsequent weaning duration.

Methods: Retrospective review of medical records of adults with tracheostomies treated at an academic medical center from 2011 to 2015. A new ventilator independence score based on ventilator settings on the day after tracheostomy was developed. Scores range from 0% to 100%; higher scores reflect greater levels of unassisted breathing for a greater proportion of the day. A multi-variable competing-risk survival regression model was used to determine the association between the ventilator independence score and time from tracheostomy placement to ventilator liberation.

Results: Of 372 patients, 72% were liberated from mechanical ventilation. The ventilator independence score measured on the day after tracheostomy placement had an area under the receiver operating characteristic curve value of 0.71 (95% CI, 0.65-0.76) for differentiating patients who were liberated within the next 14 days from those who were not. Median time from tracheostomy placement to ventilator liberation was 41 days for patients with a score of 0%, 20 days for scores between 0% and 50%, 15 days for scores between 50% and 75%, and 10 days for scores between 75% and 100%.

Conclusions: A score derived from ventilator settings may help clinicians predict the timing of ventilator liberation in patients requiring prolonged mechanical ventilation.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Body Mass Index
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Respiration, Artificial / nursing
  • Respiratory Distress Syndrome / nursing
  • Respiratory Distress Syndrome / therapy*
  • Retrospective Studies
  • Severity of Illness Index
  • Sex Factors
  • Socioeconomic Factors
  • Time Factors
  • Tracheostomy / nursing*
  • Ventilator Weaning / nursing*