Predictors of Weaning Failure in Asthma Exacerbation in Mechanically Ventilated Patients

Tuesday, February 25, 2025

12:15pm – 1:15pm Eastern Time

Location: Connections Central Theater 1

Farrah R. Khan, MD

Disclosure(s): No relevant financial relationship(s) to disclose.
SA

Salman Ayaz, MD

Internal Medicine Physician
Northwell Health

Disclosure information not submitted.
TZ

Tawanda Zinyandu, MD

Internal Medicine Resident
Yale New Haven Health Bridgeport Hospital

Disclosure information not submitted.
PG

Paridhi Ghai, MD

Internal Medicine Resident
Yale New Haven Health Bridgeport Hospital

Disclosure information not submitted.
JK

Jessica Kaushal, MD

Internal Medicine Resident
Yale New Haven Health Bridgeport Hospital

Disclosure information not submitted.
AG

Alejandro S. Garcia, MD (he/him/his)

Resident Physician
Department of Medicine, Yale New Haven Health Bridgeport Hospital

Disclosure information not submitted.
ZK

Zahra Khan, MD

Medical Student
CMH Lahore

Disclosure information not submitted.
RH

Rasha Hamid Numan Saleh, MD

Internal Medicine Resident
The Brooklyn Hospital Center Clinical and Academic Affiliate of Mt Sinai

Disclosure information not submitted.

Disclosure(s):

Farrah R. Khan, MD: No relevant financial relationship(s) to disclose.

Introduction: Severe asthma exacerbations can require mechanical ventilation. We aim to identify factors associated with failure to wean from mechanical ventilation using a retrospective analysis of National Inpatient Sample (NIS).

Methods: We performed a retrospective study using the NIS database (2016-2020). Adult patients admitted with a principal diagnosis of acute asthma exacerbation that required intubation within 48 hours of admission were included in the study. Tracheostomy performed within the same hospital stay was used as a surrogate marker for weaning failure, dividing patients into an extubation failure group and non-failure group. Baseline demographics and potential predictors of weaning failure were analyzed using univariate and multivariate logistic regression analysis.

Results: A total of 10,254 patients met study inclusion criteria. Of these, 519 patients were in the extubation failure group and 9,735 were in non-failure group. The study population was predominantly female (64.7%) with a mean age of 53.0 years. There were no statistically significant differences in age and sex between groups. Patients in the extubation failure group were more likely to be of non-white race, have a diagnosis of heart failure, chronic kidney disease, or electrolyte derangements (p < 0.001). The extubation failure group also had increased length of hospital stay (LOS) (27.0 vs 7.0, p< 0.001) and higher rates of ventilator (VAP) and community acquired pneumonias (CAP) (9.6% vs 0.9% and 55 vs 34% respectively, p< 001). In the univariable logistic regression analysis, independent predictors of extubation failure included obesity hypoventilation syndrome (OR 2.26, 1.72-2.97, p < 0.001), race (Non-White vs White) (OR 0.79, 0.66-0.95, p = 0.011), acute kidney injury (OR 2.09, 1.75-2.50, p < 0.001), VAP (OR 11.42, 7.99-16.34, p < 0.001), CAP (OR 2.40, 2.01-2.86, p < 0.001), aspiration pneumonia (OR 1.84, 1.47-2.30, p < 0.001), and electrolyte derangements (OR 3.01, 2.50-3.63, p < 0.001). These factors remained significant in the multivariable analysis. Weaning failure was associated with a longer LOS, but not with increased mortality.

Conclusions: The study identified predictors of weaning failure in mechanically ventilated asthmatic patients, helping identify high-risk patients for worse outcomes.