Transcutaneous CO2 monitoring: a new tool to identify spontaneous breathing trial failure during weaning from mechanical ventilation. A pilot cohort study

2016 ◽  
Vol 42 (6) ◽  
pp. 1078-1079 ◽  
Author(s):  
Juliana Henao-Brasseur ◽  
Jérôme Bedel ◽  
Gurkan Mutlu ◽  
David Grimaldi ◽  
François Brasseur ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Weaning From Mechanical Ventilation ◽  
Co2 Monitoring ◽  
Trial Failure

Comparative Study between Automatic Tube Compensation (ATC) and Pressure Support Ventilation (PSV) as a Mode of Weaning from Mechanical Ventilation in Patients with Respiratory Failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed N Elshaer ◽  
Ahmed A Elshebiny ◽  
Mariam K Habib ◽  
Mohammed G Abdelrasol
Keyword(s):  
Mechanical Ventilation ◽  
Endotracheal Tube ◽  
Predictive Value ◽  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Weaning From Mechanical Ventilation ◽  
Group I ◽  
Number Of Patients ◽  
Significant Difference ◽  
Successful Extubation

Abstract Background Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube (ETT). Weaning from mechanical ventilation (MV) is a challenge. Its prolongation is related to increased mortality. Aim of the Work is to assess the value of ATC in predicting successful weaning and hastening the weaning process. This study will compare the benefits and effects of ATC versus PSV as weaning modes on spontaneous breathing trials and work of breathing. Patients and Mehtods This prospective non randomized was done on 50 adult patients admitted to the Critical Care Medicine Department in Ain shams University Hospital presenting with ARF and mechanically ventilated for at least 24 hours. They were divided into two groups: Group I “ATC group” Each underwent a 1-hour spontaneous breathing trial, using ATC mode and Group II “PSV group” PSV mode was used. Results In the present study we have found that the use of ATC during a spontaneous breathing trial was as effective as PSV in predicting the ability of patients to maintain spontaneous, unassisted breathing for more than 48 hours after removal of the endotracheal tube. In our study, there was no significant difference in the number of patients who tolerated the spontaneous breathing trial and then extubated between ATC and PSV groups (60 % vs. 56% respectively, p > 0.05). Both modes had comparable sensitivity, and +ve predictive value. Sensitivity was 80.0% versus 75.0% and the positive predictive value was 88.0%, versus 87.0% for ATC versus PSV respectively. The specificity was comparable (76.8% versus 80.0 % in ATC versus PSV respectively). ATC group had higher negative predictive than PSV group (82.0% versus 70.1%, respectively). In our study, criteria for successful extubation were met in 56.0%. In ATC group 60.0% met the criteria for successful extubation vs. 60% in PSV group. In the present study it was found that male patients were the most predominant in both groups (72.0% in ATC group and 68% in PSV group). This is expected as cigarette smoking is prevalent among males and is the single most important and most prevalent risk factor for the development of COPD. In our study, about one third of patients had COPD exacerbation as a cause for ARF. Conclusion In ICU population, ATC was safe, reliable, and can be reasonably used for weaning trials. ATC confers a potential benefit in weaning duration, weaning category, number of Ss, failure of first SBT extubation outcome, ICU length of stay, complication, and mortality rate. In addition, ATC improves the predictive value of RR/TV and IWI in predicting weaning success.

scholarly journals Product of driving pressure and respiratory rate for predicting weaning outcomes

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110100
Author(s):  
Ju Gong ◽  
Bibo Zhang ◽  
Xiaowen Huang ◽  
Bin Li ◽  
Jian Huang
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Rate ◽  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Plateau Pressure ◽  
Driving Pressure ◽  
Failure Group ◽  
Rapid Shallow Breathing Index ◽  
Weaning Failure ◽  
Shallow Breathing

Objective Clinicians cannot precisely determine the time for withdrawal of ventilation. We aimed to evaluate the performance of driving pressure (DP)×respiratory rate (RR) to predict the outcome of weaning. Methods Plateau pressure (Pplat) and total positive end-expiratory pressure (PEEPtot) were measured during mechanical ventilation with brief deep sedation and on volume-controlled mechanical ventilation with a tidal volume of 6 mL/kg and a PEEP of 0 cmH2O. Pplat and PEEPtot were measured by patients holding their breath for 2 s after inhalation and exhalation, respectively. DP was determined as Pplat minus PEEPtot. The rapid shallow breathing index was measured from the ventilator. The highest RR was recorded within 3 minutes during a spontaneous breathing trial. Patients who tolerated a spontaneous breathing trial for 1 hour were extubated. Results Among the 105 patients studied, 44 failed weaning. During ventilation withdrawal, DP×RR was 136.7±35.2 cmH2O breaths/minute in the success group and 230.2±52.2 cmH2O breaths/minute in the failure group. A DP×RR index >170.8 cmH2O breaths/minute had a sensitivity of 93.2% and specificity of 88.5% to predict failure of weaning. Conclusions Measurement of DP×RR during withdrawal of ventilation may help predict the weaning outcome. A high DP×RR increases the likelihood of weaning failure. Statement: This manuscript was previously posted as a preprint on Research Square with the following link: https://www.researchsquare.com/article/rs-15065/v3 and DOI: 10.21203/rs.2.24506/v3

Mechanical Ventilation: Approaches and Special Considerations

2018 ◽  
Author(s):  
Adrian A. Maung ◽  
Lewis J Kaplan
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Key Words ◽  
Spontaneous Breathing ◽  
Functional Unit ◽  
Spontaneous Breathing Trial

In this chapter, we complete the discussion of mechanical ventilation by examining approaches to mechanical ventilation for different patient populations and how to assess whether a patient is ready for liberation from mechanical ventilation. Each of the three chapters is intended to build on the preceding one and therefore establishes a functional unit with regard to mechanical ventilation, whether it is provided in an invasive or a noninvasive fashion.  This review contains 1 Figure, 1 Table and 31 references Key Words: acute respiratory failure, ARDS, mechanical ventilation liberation, spontaneous breathing trial, tracheostomy 

Patients on Weaning Trials Classified with Neural Networks and Features Selection

2008 ◽  
pp. 1061-1067
Author(s):  
B. Giraldo ◽  
A. Garde ◽  
C. Arizmendi ◽  
R. Jane ◽  
I. Diaz ◽  
...  
Keyword(s):  
Neural Network ◽  
Neural Networks ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Spontaneous Breathing ◽  
Selection Procedure ◽  
Respiratory Pattern ◽  
Features Selection ◽  
Weaning From Mechanical Ventilation ◽  
Pattern Variability

One of the challenges in intensive care is the process of weaning from mechanical ventilation. We studied the differences in respiratory pattern variability between patients capable of maintaining spontaneous breathing during weaning trials, and patients that fail to maintain spontaneous breathing. In this work, neural networks were applied to study these differences. 64 patients from mechanical ventilation are studied: Group S with 32 patients with Successful trials, and Group F with 32 patients that Failed to maintain spontaneous breathing and were reconnected. A performance of 64.56% of well classified patients was obtained using a neural network trained with the whole set of 35 features. After the application of a feature selection procedure (backward selection) 84.25% was obtained using only eight of the 35 features.

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