Michels-Zetsche Julia Dorothea, Röser Evelyn, Ersöz Hilal, Neetz Benjamin, Dahlhoff Jana C, Joves Biljana, Trinkmann Frederik, Höger Philipp, Kontogianni Konstantina, Weissmann Cornelia, Barre Max, Fähndrich Sebastian, Bornitz Florian, Müller Michael M, Herth Felix, Trudzinski Franziska
Department of Pneumology and Critical Care, Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Germany
Department of Thoracic Surgery, Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Germany.
BMJ Open Respir Res. 2025 Jun 1;12(1):e002730. doi: 10.1136/bmjresp-2024-002730.
Older age has been identified in many studies as a predictor of poor outcomes in intensive care, including weaning failure. Age is a risk factor for prolonged weaning, resulting in an increased number of geriatric patients being referred to specialist weaning centres. The aim of our analysis was to investigate weaning outcomes in different age groups.
We analysed patients in prolonged weaning at Thoraxklinik Heidelberg from 1 December 2008 to 31 December 2023. We classified three groups: ≤64, 65-79 and ≥80 years of age. The patients' characteristics and weaning success, as well as weaning failure (continued invasive mechanical ventilation (IMV) and death), were analysed using group comparisons and logistic regression analyses.
During the study period, 915 patients (64.9±13.7 years, 39.3% female) underwent prolonged weaning. 73.3% were successfully weaned, 20.2% were discharged with IMV and 6.6% died. 40.5% of the patients were ≤64 years, 49.7% were 65-79 years and 9.7% were ≥80 years old. There was a significant difference in weaning success: in the group ≤64 years the success rate was 79.0%, 65-79 years 70.3% and ≥80 years 64.0%, p=0002. The patients' characteristics differ in the age groups, with more postoperative patients, delirium and cardiovascular comorbidities and less neuromuscular disease and malignancy in ≥80 years old patients.
64% of carefully selected patients ≥80 years of age could be successfully weaned in a specialised centre instead of being discharged from a general intensive care unit with continuing IMV in an outpatient intensive care setting.
在许多研究中，高龄已被确定为重症监护不良结局的预测因素，包括撤机失败。年龄是延长撤机时间的风险因素，导致越来越多的老年患者被转诊至专业撤机中心。我们分析的目的是调查不同年龄组的撤机结局。
我们分析了2008年12月1日至2023年12月31日在海德堡胸科医院延长撤机时间的患者。我们将患者分为三组：≤64岁、65 - 79岁和≥80岁。使用组间比较和逻辑回归分析对患者的特征、撤机成功情况以及撤机失败情况（持续有创机械通气（IMV）和死亡）进行分析。
在研究期间，915例患者（64.9±13.7岁，39.3%为女性）接受了延长撤机。73.3%的患者成功撤机，20.2%的患者撤机后带IMV出院，6.6%的患者死亡。40.5%的患者≤64岁，49.7%的患者为65 - 79岁，9.7%的患者≥80岁。撤机成功率存在显著差异：≤64岁组的成功率为79.0%，65 - 79岁组为70.3%，≥80岁组为64.0%，p = 0.002。不同年龄组患者的特征有所不同，≥80岁的患者术后患者、谵妄和心血管合并症更多，而神经肌肉疾病和恶性肿瘤更少。
在专业中心，64%精心挑选的≥80岁患者能够成功撤机，而不是在门诊重症监护环境中继续接受IMV并从普通重症监护病房出院。
