Influencing factors for weaning failure after mechanical ventilation in patients with COPD complicated by type Ⅱ respiratory failure

HU Dengyuan; YAN Xiuxia

doi:10.3969/j.issn.2097-7026.2025.06.015

Abstract：Objective To explore the risk factors for weaning failure in patients with chronic obstructive pulmonary disease(COPD)complicated by type II respiratory failure undergoing mechanical ventilation,and to construct a risk prediction model.Methods A retrospective study of clinical data was conducted on 188 patients with COPD complicated by type II respiratory failure who received mechanical ventilation treatment(admitted from May 2022 to May 2024).The patients were divided into weaning failure group and weaning success group based on weaning outcomes.Clinical data of the two groups were compared,logistic regression analysis was used to analyze the risk factors for weaning failure,a prediction model was established,and receiver operating characteristic(ROC)curve was used to evaluate its predictive efficacy.Results The weaning failure rate was 27.13%among 188 patients with COPD complicated by type II respiratory failure.Compared with the weaning success group,the weaning failure group had higher age,Acute Physiology and Chronic Health Evaluation II(APACHE II)score,proportion of mechanical ventilation time≥7 d,hs-CRP/albumin(ALB),and rapid shallow breathing index(P<0.05),and a longer course of COPD(P<0.05).Logistic regression analysis showed that elevated APACHE II score(OR=1.122,95%CI=1.043-1.207),mechanical ventilation time≥7 d(OR=2.423,95%CI=1.094-5.365),elevated hs-CRP/ALB(OR=22.899,95%CI=5.575-94.054),and elevated rapid shallow breathing index(OR=1.100,95%CI=1.054-1.148)were all independent risk factors for weaning failure in patients with COPD complicated by type II respiratory failure(P<0.05).The ROC curve showed that when the threshold was set at 0.400,the maximum Youden index was 0.679,and the area under the curve for the model predicting weaning failure was 0.874(95%CI:0.807-0.941).The Hosmer-Lemeshow test(χ 2=0.904,P=0.339)showed that the predicted probability of the model was highly consistent with the actual observed values.Conclusion The weaning failure rate after mechanical ventilation in patients with COPD complicated by type II respiratory failure is relatively high.APACHE II score,mechanical ventilation time,hs-CRP/ALB,and rapid shallow breathing index are all important influencing factors.The prediction model constructed based on these factors has certain predictive value for weaning failure in patients.