Annals of
Intensive Care volume 15,
Article number: 13 (2025)
Published: 20 January 2025
Objective
To understand the
impact of both frailty and chronologic age on outcomes of weaning from invasive
mechanical ventilation (MV).
Methods
The study
population consisted of patients enrolled in the ‘WorldwidE. AssessmeNt of
Separation of pAtients From ventilatory assistancE (WEAN SAFE) study. We
defined 4 non-overlapping groups, namely: ‘frail’ (clinical frailty scale [CFS]
score > 4; age < 80 years); ‘elderly’ (CFS ≤ 4; age ≥ 80y), ‘frail \elderly’ (CFS > 4;
age ≥ 80 years), and a ‘not frail or elderly’ population. The
primary outcome was the impact of frailty and older age on delayed weaning and
failed weaning from invasive MV. Secondary outcomes included the impact of
frailty and age on ICU and hospital survival.
Results
In the study
population, 760 (17%) were frail, while 360 (8%) were elderly, 197 (4%) were
frail and elderly, while 3,176 (70%) were not frail or elderly. The frail and
elderly cohorts were more likely to be female, had hypoxemic/hypercapnic
respiratory failure or sepsis, and had more comorbidities. The proportion of
delayed weaning and of failed weaning from invasive MV was significantly higher
in the frail (28 and 23%), the elderly (25 and 19%), and the frail and elderly
groups (22% and 25%), compared to the not frail or elderly population (12% and
13%, P < 0.01). ICU and hospital mortality was higher
in the frail (21 and 33%), the elderly (19 and 31%), and the frail and elderly
groups (26 and 46%), compared to the not frail or elderly population (12% and
18%, P < 0.001). In multivariate analyses, there was
an independent association between frailty and delayed weaning initiation and
weaning failure. Old age was independently associated with risk of weaning
failure.
Conclusions
Frailty status had
a more consistent impact than older age on weaning outcomes. However, overall
outcomes in these cohorts are encouraging once separation attempts have been
initiated.
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