Dataset Information

Validation of a new WIND classification compared to ICC classification for weaning outcome.

ABSTRACT:

Background

Although the WIND (Weaning according to a New Definition) classification based on duration of ventilation after the first separation attempt has been proposed, this new classification has not been tested in clinical practice. The objective of this cohort study was to evaluate the clinical relevance of WIND classification and its association with hospital mortality compared to the International Consensus Conference (ICC) classification.

Methods

All consecutive medical ICU patients who were mechanically ventilated for more than 24 h between July 2010 and September 2013 were prospectively registered. Patients were classified into simple, difficult, or prolonged weaning group according to ICC classification and Groups 1, 2, 3, or no weaning (NW) according to WIND classification.

Results

During the study period, a total of 1600 patients were eligible. These patients were classified by the WIND classification as follows: Group NW?=?580 (36.3%), Group 1?=?617 (38.6%), Group 2?=?186 (11.6%), and Group 3?=?217 (13.6%). However, only 735 (45.9%) patients were classified by ICC classification as follows: simple weaning?=?503 (68.4%), difficult weaning?=?145 (19.7%), and prolonged weaning?=?87 (11.8%). Clinical outcomes were significantly different across weaning groups by ICC classification and WIND classification. However, there were no statistical differences in successful weaning rate (96.6% vs. 95.2%) or hospital mortality (22.5% vs. 25.5%) between simple and difficult weaning groups by the ICC. Conversely, there were statistically significant differences in successful weaning rate (98.5% vs. 76.9%) and hospital mortality (21.2% vs. 33.9%) between Group 1 and Group 2 by WIND.

Conclusions

The WIND classification could be a better tool for predicting weaning outcomes than the ICC classification.

SUBMITTER: Jeong BH

PROVIDER: S-EPMC6265356 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Publications

Validation of a new WIND classification compared to ICC classification for weaning outcome.

Jeong Byeong-Ho BH Lee Kyeong Yoon KY Nam Jimyoung J Ko Myeong Gyun MG Na Soo Jin SJ Suh Gee Young GY Jeon Kyeongman K

Annals of intensive care 20181129 1

<h4>Background</h4>Although the WIND (Weaning according to a New Definition) classification based on duration of ventilation after the first separation attempt has been proposed, this new classification has not been tested in clinical practice. The objective of this cohort study was to evaluate the clinical relevance of WIND classification and its association with hospital mortality compared to the International Consensus Conference (ICC) classification.<h4>Methods</h4>All consecutive medical IC ...[more]

PMID: 30498971

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Project description:BACKGROUND:The outcomes of weaning processes are not well known in pediatric patients, and the International Conference Classification on weaning from mechanical ventilation showed limited application. We evaluate the relationship between the new Weaning according to a New Definition (WIND) classification and outcome in pediatric patients. METHODS:We conducted a retrospective cohort study in a tertiary pediatric intensive care unit (ICU). We included patients under 18 years of age who received invasive mechanical ventilation for more than 24 h and excluded cases with other than the first ICU admissions, tracheostomy with home ventilation before admission, intubation or weaning processes conducted in other ICU, and weaning with extracorporeal membrane oxygenation. Weaning processes were classified into four groups according to weaning duration after the first separation attempt (SA): no-SA, short weaning (< 24 h), difficult weaning (24 h-7 days), and prolonged weaning (> 7 days). Mortality rates were compared across groups using the Kruskal-Wallis test, and risk factors for the no-SA group were analyzed by multivariate logistic regression tests with age, sex, severity score at admission, admission type, and underlying disease as variables. RESULTS:Among 313 patients, 224 were enrolled and had a median age of 2.1 (interquartile range 0.5-6.6) years. Spontaneous breathing tests were done in 70.1% of enrolled patients. The median duration of intubation to the first SA was 4 (range 0-36) days, and 92.8% patients underwent the first SA within 14 days. The mortality rate was 0% in the short (0/99) and difficult (0/53) weaning groups and 17.9% (5/28) in the prolonged weaning group (p < 0.001). The mortality rate of the no-SA group was 93.2% (41/44). Admission severity (hazard ratio 1.036, confidence interval 1.022-1.050) and underlying oncologic disease (hazard ratio 7.341, confidence interval 3.008-17.916) were independent risk factors for lack of SA. CONCLUSIONS:In conclusion, WIND classification is associated with ICU mortality in pediatric patients. Further studies of this association are required to improve protocols associated with the weaning process and clinical outcomes. Trial registration Retrospectively registered.

Dataset Information

Validation of a new WIND classification compared to ICC classification for weaning outcome.

Background

Methods

Results

Conclusions

Publications

Validation of a new WIND classification compared to ICC classification for weaning outcome.

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