Validation of the Modified Integrative Weaning Index as a Predictor of Weaning from Mechanical Ventilation in Comparison to Conventional Weaning Indices in Adult Critically Ill Patients

Abstract Introduction Timely recognition of the return to spontaneous ventilation is essential for reducing costs, morbidity, and mortality. Delays in both removing invasive ventilatory support and excessively early removal are correlated with complications that vary according to the severity of the underlying disease. Several weaning indices and predictors were studied in an attempt to evaluate the outcome of removing ventilatory support. However, none of them have yet presented good results in discriminating the outcome of extubation, even those most used in clinical practices. Aim The aim of this study is to validate the modified integrative weaning index (mIWI) as a reliable weaning index in comparison to the conventional weaning indices in the weaning of critically ill patients from invasive mechanical ventilation. Patients Four hundred patients, above the age of 18 years, on mechanical ventilation for more than 48 hours through an endotracheal tube for any cause were randomly assigned to this study. Methods patients ready to be weaned were assessed using mIWI and conventional indices and monitored for 48 hours. The performance of the indices were assessed in both successful and unsuccessful groups. Results The performance of the mIWI was not significantly superior to the conventional weaning indices in predicting weaning success or failure than the traditional weaning indices. The cut-off value for the predicting successful weaning from mechanical ventilation for the mIWI was higher than suggested by the original study and yet in agreement with some other studies. The cut-off value for the mIWI is higher in patients above the age of 60 years. Conclusion The results of the study revealed that the mIWI is a good predictor of weaning from mechanical ventilation and assessment of pulmonary mechanics and is not significantly superior to the traditional weaning indices, yet is not a good predictor for extubation success.

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Effects Of Mechanical In-Exsufflation On Mucus Clearance In Critically Ill Patients On Invasive Mechanical Ventilation

10.21203/rs.3.rs-52429/v1 ◽

2020 ◽

Author(s):

Roberto Martinez-Alejos ◽

Joan-Daniel Martí ◽

Gianluigi Li Bassi ◽

Daniel Gonzalez-Anton ◽

Xabier Pilar-Diaz ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Invasive Technique ◽

Pulmonary Mechanics ◽

Post Intervention ◽

Mucus Clearance ◽

Registration Number ◽

Clinically Significant

Abstract Background: Mechanical insufflation-exsufflation (MI-E) is a non-invasive technique performed through the CoughAssist In-Exsufflator to simulate cough and remove mucus from proximal airways. To date, the effects of MI-E on critically ill patients on invasive mechanical ventilation (MV) are not fully elucidated. The purpose of this study was to compare the efficacy and safety of MI-E combined or not to manual chest physiotherapy (CPT) in these patients.Methods: This cross-over clinical study enrolled consecutive patients who were sedated, intubated and on MV > 48h with expected maintenance of these criteria > 24h. Over a 24-hour period, patients randomly performed two sessions of manual CPT with or without additional MI-E before tracheal suctioning. Following each procedure, volume of retrieved mucus (ml) was assessed to evaluate efficacy. We evaluated respiratory flows, pulmonary mechanics and hemodynamics before, during, and after treatment. In addition, safety of MI-E was also appraised.Results: 26 patients were included. In comparison to CPT, mucus volume retrieved was significantly higher during CPT+MI-E (0.42 [0; 1.39] ml vs 2.29 [1; 4.67] ml; p < 0.001). The respiratory system compliance immediately improved from pre and post Crs values in CPT+MI-E group (55.7 ml/cmH2O [38.3; 67.4] vs. 68.6ml/cmH2O [47.8;94.9]; p<0.001). Although, such increase was not significantly different between CPT and CPT+MI-E group (p=0.057). Heart rate significantly increased in both groups (p < 0.005) immediately after each intervention. Additionally, a significant impact on oxygenation was observed in the CPT+MI-E group when comparing the baseline values with the values one-hour post-intervention (p<0.05). Finally, several transitory hemodynamic variations occurred during both interventions, but these were non-significant and considered clinically irrelevant.Conclusion: In mechanically ventilated patients, MI-E increases the amount of secretions that can be retrieved post-CPT, without causing clinically significant adverse events.Clinical Trials Registration Number: NCT03316079 (24/11/2015; retrospectively registered)

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Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

Scientific Reports ◽

10.1038/s41598-021-90013-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yongfang Zhou ◽

Steven R. Holets ◽

Man Li ◽

Gustavo A. Cortes-Puentes ◽

Todd J. Meyer ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

History Of ◽

Training Background ◽

The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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Noninvasive and Invasive Ventilatory Support II

10.2310/7ccsp.8366 ◽

2018 ◽

Author(s):

Pauline K. Park ◽

Nicole L Werner ◽

Carl Haas

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Lung Injury ◽

Acute Respiratory Failure ◽

Ventilatory Support ◽

Underlying Disease ◽

Protective Ventilation ◽

Lung Protective Ventilation ◽

Pulmonary Mechanics ◽

Ventilator Induced Lung Injury

Invasive and noninvasive ventilation are important tools in the clinician’s armamentarium for managing acute respiratory failure. Although these modalities do not treat the underlying disease, they can provide the necessary oxygenation and ventilatory support until the causal pathology resolves. Care must be taken as even appropriate application can cause harm. Knowledge of pulmonary mechanics, appreciation of the basic machine settings, and an understanding of how common and advanced modes function allows the clinician to optimally tailor support to the patient while limiting iatrogenic injury. This second chapter reviews indications for mechanical ventilation, routine management, troubleshooting, and liberation from mechanical ventilation This review contains 6 figures, 7 tables and 60 references Keywords: Mechanical ventilation, lung protective ventilation, sedation, ventilator-induced lung injury, liberation from mechanical ventilation

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Clinical review: Helmet and non-invasive mechanical ventilation in critically ill patients

Critical Care ◽

10.1186/cc11875 ◽

2013 ◽

Vol 17 (2) ◽

pp. 223 ◽

Cited By ~ 29

Author(s):

Antonio M Esquinas Rodriguez ◽

Peter J Papadakos ◽

Michele Carron ◽

Roberto Cosentini ◽

Davide Chiumello

Keyword(s):

Mechanical Ventilation ◽

Clinical Review ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Non Invasive

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Effect of substitution of intravenous infusion of fentanyl by enteral methadone on the time of weaning from mechanical ventilation in critically ill patients in intensive care units for adults

http://isrctn.org/> ◽

10.1186/isrctn85308779 ◽

2013 ◽

Author(s):

Raquel Wanzuita

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Critically Ill Patients ◽

Intravenous Infusion ◽

Weaning From Mechanical Ventilation

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Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO)

Journal of Anesthesia, Analgesia and Critical Care ◽

10.1186/s44158-021-00015-6 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Luigi Vetrugno ◽

Francesco Mojoli ◽

Andrea Cortegiani ◽

Elena Giovanna Bignami ◽

Mariachiara Ippolito ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Working Group ◽

Lung Ultrasound ◽

Invasive Mechanical Ventilation ◽

Italian Society ◽

Expert Consensus ◽

Consensus Statements

Abstract Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging. Results A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%. Conclusion The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients.

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Comparison of International Consensus Conference guidelines and WIND classification for weaning from mechanical ventilation in Brazilian critically ill patients

Medicine ◽

10.1097/md.0000000000017534 ◽

2019 ◽

Vol 98 (42) ◽

pp. e17534

Author(s):

Alessandra Fabiane Lago ◽

Ada Clarice Gastaldi ◽

Amanda Alves Silva Mazzoni ◽

Vanessa Braz Tanaka ◽

Vivian Caroline Siansi ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Consensus Conference ◽

Weaning From Mechanical Ventilation ◽

International Consensus

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Feasibility, tolerance and effectiveness of enteral feeding in critically ill patients in prone position

Journal of the Intensive Care Society ◽

10.1177/1751143719900100 ◽

2020 ◽

pp. 175114371990010 ◽

Cited By ~ 1

Author(s):

Raymond Dominic Savio ◽

Rajalakshmi Parasuraman ◽

Daphnee Lovesly ◽

Bhuvaneshwari Shankar ◽

Lakshmi Ranganathan ◽

...

Keyword(s):

Mechanical Ventilation ◽

Enteral Nutrition ◽

Critically Ill ◽

Prone Position ◽

Supine Position ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Apache Ii ◽

Apache Ii Score ◽

The Mean

Aim To assess the feasibility, tolerance and effectiveness of enteral nutrition in critically ill patients receiving invasive mechanical ventilation in the prone position for severe Acute Respiratory Distress Syndrome (ARDS). Methods Prospective observational study conducted in a multidisciplinary critical care unit of a tertiary care hospital from January 2013 until July 2015. All patients with ARDS who received invasive mechanical ventilation in prone position during the study period were included. Patients’ demographics, severity of illness (Acute Physiology and Chronic Health Evaluation (APACHE II) score), baseline markers of nutritional status (subjective global assessment (SGA) and body mass index), details of nutrition delivery during prone and supine hours and outcomes (Length of stay and discharge status) were recorded. Results Fifty-one patients met inclusion criteria out of whom four patients were excluded from analysis since they did not receive any enteral nutrition due to severe hemodynamic instability. The mean age of patients was 46.4 ± 12.9 years, with male:female ratio of 7:3. On admission, SGA revealed moderate malnutrition in 51% of patients and the mean APACHE II score was 26.8 ± 9.2. The average duration of prone ventilation per patient was 60.2 ± 30.7 h. All patients received continuous nasogastric/orogastric feeds. The mean calories (kcal/kg/day) and protein (g/kg/day) prescribed in the supine position were 24.5 ± 3.8 and 1.1 ± 0.2 while the mean calories and protein prescribed in prone position were 23.5 ± 3.6 and 1.1 ± 0.2, respectively. Percentage of prescribed calories received by patients in supine position was similar to that in prone position (83.2% vs. 79.6%; P = 0.12). Patients received a higher percentage of prescribed protein in supine compared to prone position (80.8% vs. 75%, P = 0.02). The proportion of patients who received at least 75% of the caloric and protein goals was 37 (78.7%) and 37 (78.7%) in supine and 32 (68.1%) and 21 (44.6%) in prone position. Conclusion In critically ill patients receiving invasive mechanical ventilation in the prone position, enteral nutrition with nasogastric/orogastric feeding is feasible and well tolerated. Nutritional delivery of calories and proteins in prone position is comparable to that in supine position.

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