The pivotal role of microbiological colonization in weaning from mechanical ventilation, decannulation and rate of recovery in tracheostomized post-ICU survivors

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Background: Multidrug-resistant organisms (MDRO) colonization is a common finding in patients undergoing prolonged weaning. However little is known about MDR status as a predictor of weaning success in the difficult-weaning population, especially in the long term acute care setting. Objective: Description of the microbiological profile of critically ill tracheostomized patients and its impact on weaning and recovery. Methods: This is a single centre retrospective analysis of 69 consecutive patients who underwent tracheostomy for prolonged weaning in the intensive care and were admitted to a semi-intensive ward and eventually to a pulmonary rehabilitation hospital from January 2022 to October 2024. The influence of MDRO colonization on admission on weaning success, decannulation and discharge location was investigated. Results: Among the study cohort, 51% patients were successfully detached from mechanical ventilation and 48% were eventually decannulated. The majority of patients needed intensive care or emergency unit transfer, but readmission rate was high (54%) with 62% discharge rate and 9% in-hospital mortality universally due to sepsis. MDRO colonization was common (65%), with frequent evidence of methicillin-resistant staphylococci and enterobacteriaceae. Patients with MDROs were more usually men with heart disease and late-tracheostomy, however there were no significant difference in outcome between MDR positive or negative patients. Conclusions: Mechanical ventilation weaning is feasibile in a pulmonary rehabilitation setting designed for difficult-to-wean critically ill patients despite an high microbiological burden.

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