Weaning Readiness and Fluid Balance in Older Critically Ill Surgical Patients

• BackgroundFew studies address predictors for successful weaning of older adults from mechanical ventilation.

• ObjectiveTo develop a clinical profile of older patients who are successfully weaned from long-term mechanical ventilation.

• MethodsForty patients in the trauma and surgical intensive care unit who were at least 60 years old were enrolled in the study after 3 days of active weaning and were monitored daily until successfully weaned or until the end of the 14-day study. Hemodynamic and gas exchange variables, fluid balance, oxygen cost of breathing, and scores on the Burns Weaning Assessment Program were analyzed.

• ResultsCompared with patients who were not weaned, successfully weaned patients required mechanical ventilation for 5.3 days, started active weaning earlier (mean 10.7 vs 14.5 days, P = .04), had lower mean negative daily fluid balances in the beginning (−0.394 vs 1.107 L, P = .004), and had lower mean net cumulative fluid balances (6.856 vs 16.212 L) at the time of enrollment. They also maintained both a lower mean net cumulative fluid balance (10.753 vs 25.049 L, P= .02) and a negative daily fluid balance (−0.389 vs 1.904 L, P = .03) throughout. Their mean central venous pressure decreased over time and was significantly lower (P<.001).

• ConclusionPersistent positive fluid balance in older surgical patients is associated with prolonged mechanical ventilation. Estimates of fluid balance might be useful in weaning older patients from long-term mechanical ventilation.