Factors influencing weaning success from mechanical ventilation in Emergency department patients with acute respiratory failure.

Abstract

Objectives: To identify the clinical and physiological factors associated with successful weaning from mechanical ventilation (MV) in patients with acute respiratory failure (ARF) treated in the Emergency department, and to evaluate their short-term prognosis.

Methods: This retrospective study analyzed data from 248 ARF patients who underwent MV in the Emergency department from July 2021 to June 2024. Patients were categorized into weaning success and failure groups based on their ability to maintain spontaneous breathing for over 48 hours post-extubation. Collected variables included demographic characteristics, body mass index, MV duration, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, blood gas parameters, and diaphragm function metrics. Multivariate logistic regression was used to identify independent predictors of weaning success.

Results: Among the 248 patients, 165 (66.5%) were successfully weaned. Independent predictors of successful weaning included shorter MV duration, lower APACHE II scores, higher tidal volumes, and lower respiratory rates during spontaneous breathing trials. Diaphragmatic excursion was negatively associated with weaning failure, as was arterial oxygen partial pressure (PaO₂). Patients in the failure group had longer hospital stays and higher rates of complications, invasive interventions, and readmissions (all P<0.05).

Conclusion: Weaning success in ARF patients managed in the Emergency department is influenced by a combination of clinical severity, ventilatory parameters, and diaphragm function. Recognition of these factors may aid in optimizing weaning strategies and improving patient prognosis.