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

scholarly journals Use of the product of driving pressure and respiratory rate for predicting failure of weaning from mechanical ventilator in medical patients

2020 ◽  
Author(s):  
Ju Gong ◽  
Bibo Zhang ◽  
Xiaowen Huang ◽  
Bin Li ◽  
Jian Huang
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Rate ◽  
Spontaneous Breathing Trial ◽  
Plateau Pressure ◽  
Driving Pressure ◽  
Medical Patients ◽  
Failure Group ◽  
Weaning Failure ◽  
Weaning Outcome

Abstract Background : Respiratory workload increment in the process of mechanical ventilation withdrawal is critical for the determination of weaning outcome. Pressure, tidal volume (Vt) and respiratory rate (RR ) are considered as patient’s respiratory power, albeit being affected by excessive respiratory load. We aimed to evaluate the performance of driving pressure (DP)×RR to predict the outcome of weaning. Methods : Plateau pressure (Pplat) and positive end-expiratory pressure tot (PEEPtot) were measured during mechanical ventilation, viz., (1) brief deep sedation, (2) on volume support ventilation of MV with Vt 6 ml/kg and a PEEP of 0 cm H 2 O, (3) Pplat and PEEPtot were measured by holding breath for 2s after inhalation and exhalation, respectively. The DP was determined as Pplat minus PEEPtot. The highest RR was recorded within 3 min during spontaneous-breathing trial (SBT). Patients that were able to tolerate SBT for 1 h were directly extubated. These measurements correlated well with weaning outcome. Notably, patients in the “failure” group failed the SBT, died, while others required reintubation or noninvasive ventilation within 48 h of extubation. Results : Out of the 61 patients studied, 22 failed weaning. During the withdrawal of ventilation, DP×RR was 134.2±33.2 cmH 2 O ·breaths/min and 238.5±61.7 cmH 2 O·breaths/min ( P =0.00), DP was 7.9±1.6 cmH 2 O and 9.7±2.3 cmH 2 O ( P =0.00), in the “success” and “failure” groups, respectively. The DP×RR index greater than 170 cmH 2 O·breaths/min had a sensitivity of 95.5% and a specificity of 89.7%, while DP index greater than 8.1 cmH 2 O had 81.8% sensitivity and 64.1% specificity to predict weaning failure. Conclusions : Measurement of DP×RR during withdrawal of ventilation may help predict weaning outcome. Noticeably, high DP×RR increased the likelihood of weaning failure.

scholarly journals Use of the product of driving pressure and respiratory rate for predicting failure of weaning from mechanical ventilator in medical patients

2020 ◽  
Author(s):  
Ju Gong ◽  
Bibo Zhang ◽  
Xiaowen Huang ◽  
Bin Li ◽  
Jian Huang
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Rate ◽  
Deep Sedation ◽  
Spontaneous Breathing Trial ◽  
Plateau Pressure ◽  
Driving Pressure ◽  
Medical Patients ◽  
Weaning Failure ◽  
Weaning Outcome

Abstract Background : Respiratory workload increment in the process of mechanical ventilation withdrawal is critical for the determination of weaning outcome. Pressure, tidal volume (Vt) and respiratory rate (RR ) are considered as patient’s respiratory power, albeit being affected by excessive respiratory load. We aimed to evaluate the performance of driving pressure (DP)×RR to predict the outcome of weaning. Methods : Plateau pressure (Pplat) and positive end-expiratory pressure tot (PEEPtot) were measured during mechanical ventilation, viz., (1) brief deep sedation, (2) on volume support ventilation of MV with Vt 6 ml/kg and a PEEP of 0 cm H 2 O, (3) Pplat and PEEPtot were measured by holding breath for 2s after inhalation and exhalation, respectively. The DP was determined as Pplat minus PEEPtot. The highest RR was recorded within 3 min during spontaneous-breathing trial (SBT). Patients that were able to tolerate SBT for 1 h were directly extubated . Results : Out of the 61 patients studied, 22 failed weaning. During the withdrawal of ventilation, DP×RR was 134.2±33.2 cmH 2 O ·breaths/min and 238.5±61.7 cmH 2 O·breaths/min ( P =0.00), DP was 7.9±1.6 cmH 2 O and 9.7±2.3 cmH 2 O ( P =0.00), in the “success” and “failure” groups, respectively. The DP×RR index greater than 170 cmH 2 O·breaths/min had a sensitivity of 95.5% and a specificity of 89.7%, while DP index greater than 8.1 cmH 2 O had 81.8% sensitivity and 64.1% specificity to predict weaning failure. Conclusions : Measurement of DP×RR during withdrawal of ventilation may help predict weaning outcome. Noticeably, high DP×RR increased the likelihood of weaning failure.

scholarly journals Use of the product of driving pressure and respiratory rate for predicting failure of weaning from mechanical ventilator in medical patients

2020 ◽  
Author(s):  
Ju Gong ◽  
Bibo Zhang ◽  
Xiaowen Huang ◽  
Bin Li ◽  
Jian Huang
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Rate ◽  
Deep Sedation ◽  
Spontaneous Breathing Trial ◽  
Plateau Pressure ◽  
Driving Pressure ◽  
Medical Patients ◽  
Weaning Failure ◽  
Weaning Outcome

Abstract Background: Respiratory workload increment in the process of mechanical ventilation withdrawal is critical for the determination of weaning outcome. Pressure, tidal volume (Vt) and respiratory rate (RR) are considered as patient’s respiratory power, albeit being affected by excessive respiratory load. We aimed to evaluate the performance of driving pressure (DP)×RR to predict the outcome of weaning.Methods: Plateau pressure (Pplat) and positive end-expiratory pressure tot (PEEPtot) were measured during mechanical ventilation, viz., (1) brief deep sedation, (2) on volume support ventilation of MV with Vt 6 ml/kg and a PEEP of 0 cm H2O, (3) Pplat and PEEPtot were measured by holding breath for 2s after inhalation and exhalation, respectively. The DP was determined as Pplat minus PEEPtot. The highest RR was recorded within 3 min during spontaneous-breathing trial (SBT). Patients that were able to tolerate SBT for 1 h were extubated.Results: Out of the 61 patients studied, 22 failed weaning. During the withdrawal of ventilation, DP×RR was 134.2±33.2 cmH2O·breaths/min and 238.5±61.7 cmH2O·breaths/min (P=0.00), DP was 7.9±1.6 cmH2O and 9.7±2.3 cmH2O (P=0.00), in the “success” and “failure” groups, respectively. The DP×RR index greater than 170 cmH2O·breaths/min had a sensitivity of 95.5% and a specificity of 89.7%, while DP index greater than 8.1 cmH2O had 81.8% sensitivity and 64.1% specificity to predict weaning failure.Conclusions: Measurement of DP×RR during withdrawal of ventilation may help predict weaning outcome. Noticeably, high DP×RR increased the likelihood of weaning failure.

scholarly journals Ventilator induced Diaphragmatic Dysfunction assessed by Ultrasonography and its impact on Weaning outcome

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H M A Fawzy ◽  
M H M Hassan ◽  
A A M Alkholy
Keyword(s):  
Mechanical Ventilation ◽  
Operating Characteristics ◽  
Diaphragmatic Dysfunction ◽  
Rapid Shallow Breathing Index ◽  
Weaning Failure ◽  
Significant Difference ◽  
Shallow Breathing ◽  
Ventilation Modes ◽  
Weaning Outcome ◽  
Rapid Shallow Breathing

Abstract Background Ventilator induced diaphragmatic dysfunction (VIDD), as a loss of diaphragmatic force generating capacity due to the use of mechanical ventilation. Difficulties in discontinuing ventilatory support are encountered in 20–25% of mechanically ventilated patients, with a staggering 40% of time spent in the intensive care unit being devoted to weaning. M-mode ultrasonography is now an accepted qualitative method of assessing diaphragmatic motion in normal and pathological conditions. In this study, we evaluated whether diaphragmatic excursion (DE) as measured by M-mode sonography can be a predictor of weaning and diagnosis of VIDD. Aim The aim of this study is to determine the presence of ventilator induced diaphragmatic dysfunction (VIDD) diagnosed by M-mode ultrasonography and its impact on weaning outcome. Methodology This study was conducted prospectively in critical care unit in Ain Shams Hospital, a university-affiliated, tertiary referral center in Cairo, Egypt. Study subjects included 78 patients between August 2017 to August 2018. who required mechanical ventilation ≥72hrs. who fulfilled the spontaneous breath trial (SBT) criteria, at the start of a 1-hr SBT, each hemidiaphragm was evaluated M-mode sonography with the patient in the supine position. Rapid shallow Breathing index (RSBI) was simultaneously calculated at the bedside. Ultrasonographic Diaphragmatic Dysfunction (DD) was diagnosed if an Diaphragmatic Excursion (DE) was <10 mm or negative, the latter indicating paradoxical diaphragmatic movement. Results Diaphragmatic Dysfunction (DD) among the eligible 78 patients was 48% (n = 37). DD group had longer weaning time [39,2 (26-56) hrs. vs. 22.3 (30-16) hrs. p = 0.001) in DD vs. NDD group respectively and total ventilation time [140 (130-150) hrs. vs. 130 (120–140) hrs. p > 0.05) in DD vs. NDD group respectively. Weaning failure was (45.8% vs. 30.8%, p=0.01) in DD vs. NDD group respectively. In NDD group Rt. DE, mean 25.4 ±4.1 mm. While Lt. side was 25.3±4.6 mm, 11.25mm and 22mm (45-15) respectively. In DD group Rt. DE, mean 7.6 ±2.02mm, IQR 2.4 mm and median 8.2mm (10-1.9). While Lt. side was 9.2±0.8mm, 4.3mm and 8.9mm (9.8-5.7) respectively. The area under the receiver operating characteristics curve (ROC) of ultrasonographic criteria in predicting weaning failure was near similar to that of rapid shallow breathing index. Hypercapenic acidosis in NDD group might protect them from VIDD Conclusions DD is present in a significant percentage 48% (nearly half) of our medical ICU patients on MV ≥ 72 hrs which largely account for weaning failure. DD was associated with a significant longer weaning time, and ICU stay, with no significant difference in 30 day mortality Recommendations DE by US measurements is a valuable tool and is recommended as an adjunctive weaning index to aid prediction of weaning outcome. Evaluating the role of spontaneous ventilation modes and advanced ventilation modes as PAV and NAVA effects on decreas ing VIDD versus controlled modes.

scholarly journals Mechanical power normalized to lung-thorax compliance indicates weaning readiness in prolonged ventilated patients

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Alessandro Ghiani ◽  
Joanna Paderewska ◽  
Swenja Walcher ◽  
Konstantinos Tsitouras ◽  
Claus Neurohr ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Respiratory System ◽  
Spontaneous Breathing ◽  
Characteristic Curve ◽  
Spontaneous Breathing Trial ◽  
Mechanical Power ◽  
Binary Logistic Regression Model ◽  
Weaning Failure ◽  
Ventilated Patients

AbstractSince critical respiratory muscle workload is a significant determinant of weaning failure, applied mechanical power (MP) during artificial ventilation may serve for readiness testing before proceeding on a spontaneous breathing trial (SBT). Secondary analysis of a prospective, observational study in 130 prolonged ventilated, tracheotomized patients. Calculated MP’s predictive SBT outcome performance was determined using the area under receiver operating characteristic curve (AUROC), measures derived from k-fold cross-validation (likelihood ratios, Matthew's correlation coefficient [MCC]), and a multivariable binary logistic regression model. Thirty (23.1%) patients failed the SBT, with absolute MP presenting poor discriminatory ability (MCC 0.26; AUROC 0.68, 95%CI [0.59‒0.75], p = 0.002), considerably improved when normalized to lung-thorax compliance (LTCdyn-MP, MCC 0.37; AUROC 0.76, 95%CI [0.68‒0.83], p < 0.001) and mechanical ventilation PaCO2 (so-called power index of the respiratory system [PIrs]: MCC 0.42; AUROC 0.81 [0.73‒0.87], p < 0.001). In the logistic regression analysis, PIrs (OR 1.48 per 1000 cmH2O2/min, 95%CI [1.24‒1.76], p < 0.001) and its components LTCdyn-MP (1.25 per 1000 cmH2O2/min, [1.06‒1.46], p < 0.001) and mechanical ventilation PaCO2 (1.17 [1.06‒1.28], p < 0.001) were independently related to SBT failure. MP normalized to respiratory system compliance may help identify prolonged mechanically ventilated patients ready for spontaneous breathing.

scholarly journals Influence of lung aeration on diaphragmatic contractility during a spontaneous breathing trial: an ultrasound study

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Jing Xia ◽  
Chuan-Yun Qian ◽  
Li Yang ◽  
Mei-Ju Li ◽  
Xiao-Xue Liu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Quiet Breathing ◽  
Diaphragmatic Function ◽  
Lung Aeration ◽  
Ultrasound Study ◽  
Weaning Failure ◽  
Successful Weaning ◽  
The Right

Abstract Background A spontaneous breathing trial (SBT) is a major diagnostic tool to predict successfully extubation in patients. Several factors may lead to weaning failure, including the degree of lung aeration loss and diaphragm dysfunction. The main objective was to compare the diaphragmatic contractility between patients with high lung aeration loss and low lung aeration loss during a 30-minute SBT by ultrasound. Methods This was a prospective single-center study. Lung ultrasound aeration score (LUS) and diaphragmatic thickening fraction (DTF) were measured during mechanical ventilation 1 h before SBT (T-1), 30 min (T1), and 120 min (T2) after the start of the SBT during quiet breathing. The right and left DTF were compared between patients with LUS ≥ 14 (high lung aeration loss), considered at high risk of post-extubation distress, and those with LUS < 14 (low lung aeration loss). The relationship between the LUS and DTF and the changes in LUS and DTF from T-1 to T2 in patients with LUS ≥ 14 were assessed. Results Forty-nine patients were analyzed; 33 had LUS ≥ 14 and 16 had LUS < 14 at T1. The DTF at T1 was significantly higher in patients with LUS ≥ 14 than in those with LUS < 14: the right median (IQR) DTF was 22.2% (17.1 to 30.9%) vs. 14.8% (10.2 to 27.0%) (p = 0.035), and the left median (IQR) DTF was 25.0% (18.4 to 35.0%) vs. 18.6% (9.7 to 24.2%) (p = 0.017), respectively. There was a moderate positive correlation between the LUS and the DTF (Rho = 0.3, p = 0.014). A significant increase in the LUS was observed from T-1 to T1, whereas no change was found between T1 and T2. The DTF remained stable from T-1 to T2. Conclusions During a SBT, diaphragmatic contraction acts differently depending on the degree of pulmonary aeration. In patients with high lung aeration loss, increased diaphragmatic contractility indicates an additional respiratory effort to compensate lung volume loss that would contribute to successful SBT. Further studies are needed to evaluate the combined evaluation of lung aeration and diaphragmatic function to predict the successful weaning of patients from mechanical ventilation.

scholarly journals Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 92
Author(s):  
Anna Kyriakoudi ◽  
Nikoletta Rovina ◽  
Ourania Koltsida ◽  
Eirini Kostakou ◽  
Elissavet Konstantelou ◽  
...  
Keyword(s):  
Spontaneous Breathing Trial ◽  
Rapid Shallow Breathing Index ◽  
Weaning Failure ◽  
Septic Inflammation ◽  
Long Time ◽  
Shallow Breathing ◽  
The Right ◽  
Relative Mrna Expression ◽  
Experience Difficulty ◽  
Time Point

Introduction: Septic patients undergoing mechanical ventilation (MV) often experience difficulty in weaning. Th aim of this study was to determine whether inflammatory biomarkers of sepsis could be indicative of the failure or success of spontaneous breathing trial (SBT) in these patients. Methods: Sixty-five patients on MV (42 septic and 23 intubated for other reasons) fulfilling the criteria for SBT were included in the study. Blood samples were collected right before, at the end of (30 min) and 24 h after the SBT. Serum inflammatory mediators associated with sepsis (IL-18, IL-18BP, TNF) were determined and correlated with the outcome of SBT. Results: A successful SBT was achieved in 45 patients (69.2%). Septic patients had a higher percentage of SBT failure as compared to non-septic patients (85% vs. 15%, p = 0.026), with an odds ratio for failing 4.5 times (OR = 4.5 95%CI: 1.16–17.68, p 0.022). IL-18 levels and the relative mRNA expression in serum were significantly higher in septic as compared to non-septic patients (p < 0.05). Sepsis was independently associated with higher serum IL-18 and TNF levels in two time-point GEE models (53–723, p = 0.023 and 0.3–64, p = 0.048, respectively). IL-18BP displayed independent negative association with rapid shallow breathing index (RSBI) (95% CI: −17.6 to −4, p = 0.002). Conclusion: Sustained increased levels of IL-18 and IL-18BP, acknowledged markers of sepsis, were found to be indicative of SBT failure in patients recovering from sepsis. Our results show that, although subclinical, remaining septic inflammation that sustaines for a long time complicates the weaning procedure. Biomarkers for the estimation of the septic burden and the right time for weaning are needed.

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