Introduction

Severe asthma exacerbations can necessitate mechanical ventilation, but some patients struggle to wean off it. This study aimed to identify factors associated with weaning failure using a retrospective analysis of the National Inpatient Sample (NIS) database from 2016–2020.

Method

Adult patients admitted with acute asthma exacerbation requiring intubation within 48 hours of admission were included. Tracheostomy performed during hospitalization served as a surrogate marker for weaning failure, dividing patients into extubation failure and non-failure groups. Univariate and multivariate logistic regression analyses were conducted to identify predictors of weaning failure.

Results

• Study Population: 10,254 patients met the inclusion criteria, with 519 in the extubation failure group and 9,735 in the non-failure group.
• Demographics: The majority were female (64.7%), with a mean age of 53 years. No significant differences in age or sex were observed between groups.

Key Findings

• Predictors of Weaning Failure
  • Non-white race
  • Heart failure
  • Chronic kidney disease
  • Electrolyte derangements (p < 0.001)
  • Obesity hypoventilation syndrome (OR 2.26, p < 0.001)
  • Acute kidney injury (OR 2.09, p < 0.001)
  • Ventilator-associated pneumonia (VAP) (OR 11.42, p < 0.001)
  • Community-acquired pneumonia (CAP) (OR 2.40, p < 0.001)
  • Aspiration pneumonia (OR 1.84, p < 0.001)
• Clinical Outcomes

• Patients with weaning failure had significantly longer hospital stays (27 vs. 7 days, p < 0.001).
• Higher incidence of VAP (9.6% vs. 0.9%) and CAP (55% vs. 34%) (p < 0.001).
• Weaning failure was not associated with increased mortality.

Conclusion

This study identified key predictors of weaning failure in mechanically ventilated asthmatic patients, helping clinicians recognize high-risk individuals. These findings may guide early interventions to improve outcomes.

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