Maximum Inspiratory Pressure Linked to Ventilator Weaning Outcomes in Patients With COVID-19

Maximum inspiratory pressure was linked to wean status in patients with COVID-19 receiving treatment at long-term acute care hospitals (LTACHs), according to findings from a retrospective cohort study.

“Liberation from [mechanical ventilation] has been a challenge in the COVID-19 population with a large number of individuals subjected to [prolonged mechanical ventilation],” researchers wrote. “Many studies have sought to examine the parameters for weaning in the ICU setting, but few have discussed weaning strategies in LTACHs.”

Authors examined outcome measures related to prolonged mechanical ventilation weaning among 25 patients with a history of COVID-19. The sample included mostly male patients with overweight and diabetes, diaphragmatic dysfunction, and no history of chronic obstructive pulmonary disease or sleep apnea. Patients were, on average, 58 years of age.

The primary outcome of the study was wean status at discharge. Weaning was considered successful if patients were liberated from mechanical ventilation for at least 48 hours by the time they were discharged.

Authors accounted for the following variables: maximum inspiratory pressure, maximum expiratory pressure, forced vital capacity (FVC), forced expiratory volume in one second/forced vital capacity (FEV1/FVC), diaphragmatic dysfunction (bilateral/unilateral/none), and partial pressure of carbon dioxide (PCO2).

Just over half of patients (53.8%) were successfully weaned at time of discharge after a median length of stay of 41 days. Per the findings, there was a “significant association” between maximum inspiratory pressure (OR 95% CI .87-.99; P= .0391) and wean status.

Mean FVC and PCO2 were found to be .6±.3% and 51.4±9.7, respectively. Maximum expiratory pressure was an average of 43.9±16.7 cmH2O, and maximum inspiratory pressure was an average of -36.5±15.9 cmH2O.

Although they noted further studies were needed to confirm their findings, authors concluded that maximum inspiratory pressure “may have the potential to help prognosticate weaning outcomes in the COVID-19 population.”

Reference:
Barchuk S, Barchuk A, Delgado A, Galassi K. Ventilator weaning outcomes in SARs-CoV-2 (+) individuals in the LTACH setting-a retrospective cohort study. Arch Phys Med Rehabil. 2021;102(10):e41. doi:10.1016/j.apmr.2021.07.583