Determinants of Weaning Failure Among Adult Patients on Invasive Mechanical Ventilation in Kenyatta National Hospital Intensive Care Unit.

Abstract

Background: Weaning failure from mechanical ventilation has become a major challenge in management of patients in intensive care unit (ICU). Approximately 20% of patients on invasive mechanical ventilation fail to wean successfully in the first attempt. There are different factors that contribute to weaning failure which might be caused by patient characteristics as well as healthcare professionals’ knowledge in weaning patients from mechanical ventilation. Thus, there is need to understand the current trends and determinants of weaning failure in mechanical ventilation. Objective of the study: To establish the prevalence and determinants of weaning failure among critically ill adult patients on invasive ventilation at Kenyatta National Hospital intensive care unit. Methods: This was a cross sectional study which incorporated a retrospective review of patients’ files as well as assessing nursing practice in weaning. The study employed consecutive sampling where 246 patients’ files from January 2019 to December 2019 were retrieved. Stratified sampling method were used to categorize nurses into their cadres followed by simple random sampling method which was be applied in the selection of 60 critical care nurses as participants from the strata. A data abstraction tool and questionnaire was used to collect data from patient’s medical files and from the nurses respectively. Results: The results showed that 163(66%) of patients were male. The average age was 43±15 years, the length of stay in the ICU was 33±24days, duration on MV was 9±6 days. Among nurses who participated in the study, 54(93%) had higher diploma as their highest level of education while 51(88%) asserted that they had attended a training in critical care nursing. The prevalence of weaning failure was 71(29%). The findings also showed that There was a significant difference in weaning failure among different older age x2 (2) = 6.779, p = 0.034. cigarette smokers, x2 (1) = 4.746, p = 0.024, low HB level, x2 (1) = 41.04, p = 0.00, CPAP mode of weaning, x2 (1) = 53.5, p = 0.000 and longer duration on MV, x2 (2) = 31.54, p = 0.000 were associated with weaning failure. Binary logistic regression showed that, Lower hemoglobin level, (OR =12.896, 95%CI, (4.2 -39.57, p = 0.000), CPAP mode of weaning, (OR =3.457, 95%CI, (2.029 – 5.891, p = 0.000), and longer duration on mechanical ventilation, (OR =2.92, 95%CI, (1.5 – 21.08, p = 0.000). Conclusion: The results have shown that it is essential to control HB level, cigarette smoking, duration on MV as well as consider alternative for CPAP mode of weaning to increase the chances of weaning success among patients on Invasive mechanical ventilation. It is essential to consider alternative approaches to wean patients with these conditions to increase the chances of weaning success. Nurses in critical care have shown a moderate level of understanding on weaning practice for successful outcome.