Outcomes after Prolonged Weaning in Chronic Obstructive Pulmonary Disease Patients: Data from the German WeanNet Initiative

Abstract

Background: The outcome of prolonged weaning in COPD patients is still unclear.

Methods: A subgroup analysis of 2,937 COPD patients (median: age 69 years, 5 comorbidities, 43% female) from the entire WeanNet cohort of specialized German weaning centers previously published (N = 11,424) was performed.

Results: Weaning outcomes were as follows: successful weaning without subsequent long-term noninvasive ventilation (NIV): N = 900; 30.6%; successful weaning with subsequent long-term NIV: N = 900; 30.6%; weaning failure with subsequent long-term invasive ventilation: N = 780; 26.6%; and death: N = 357; 12.2%. Most important predictors of mortality and weaning failure were advanced age and duration of mechanical ventilation in the transferring ICU, respectively. On discharge, the tracheostoma was closed in only 53% and 59% of patients with successful weaning not receiving and receiving long-term NIV, respectively. Unsuccessfully weaned patients were predominantly discharged home (20.5%) or to long-term care facilities (57.2%). Successfully weaned patients were predominantly discharged home (22.4%/35.9%: without/with NIV) and to rehabilitation (41.0%/43.1%: without/with NIV), respectively.

Conclusion: COPD forms an important subgroup of prolonged weaning patients. Following transfer from the ICU to a specialized weaning center, weaning is successful more than 60%. Importantly, both tracheostomy status and initial destination following discharge are highly dependent on the weaning outcome.

Keywords: Chronic obstructive pulmonary disease; Noninvasive ventilation; Rehabilitation; Tracheotomy; Weaning.