An Integrative Index for Predicting Extubation Outcomes After Successful Completion of a Spontaneous Breathing Trial in an Adult Medical Intensive Care Unit

2017 ◽  
Vol 34 (8) ◽  
pp. 640-645 ◽  
Author(s):  
Tsung-Ju Wu ◽  
Judith Shu-Chu Shiao ◽  
Hsin-Liang Yu ◽  
Ruay-Sheng Lai
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Serum Albumin ◽  
Spontaneous Breathing ◽  
Characteristic Curve ◽  
Spontaneous Breathing Trial ◽  
Invasive Mechanical Ventilation ◽  
Extubation Failure ◽  
Rapid Shallow Breathing Index ◽  
Medical Intensive Care

Background: Among respiratory predictors, rapid shallow breathing index (RSBI) has been a commonly used respiratory parameter to predict extubation outcomes. However, the outcome of prediction remains inconsistent. Regarding nonrespiratory predictors, serum albumin, hemoglobin, bicarbonate, and patients’ alertness have been reported to be associated with successful weaning or extubation. We aimed to develop an integrative index combining commonly used predictors in the adult medical intensive care units (MICUs) and to compare the predictability of the index with RSBI. Methods: This prospective observational study with retrospective data collection of planned extubations was conducted in a 14-bed adult MICU. We enrolled patients who received mechanical ventilation via an endotracheal tube in the adult MICU for >24 hours and passed a 2-hour spontaneous breathing trial and underwent extubation. Extubation failure was defined as reinstitution of invasive mechanical ventilation within 48 hours of extubation. Respiratory parameters and Glasgow Coma Scale (GCS) scores of patients were recorded prospectively. Nonrespiratory parameters were recorded retrospectively. Logistic regression was used to determine significant predictors of extubation outcomes. Results: Fifty-nine patients comprising 70 extubations were enrolled. Extubation failure was significantly and positively associated with lower serum albumin (albumin < 2.6 g/dL, odds ratio [OR] = 5.1; 95% confidence interval [CI], 1.04-24.66), lower hemoglobin (hemoglobin < 10.0 g/dL, OR = 10.8; 95% CI, 2.00-58.04), and lower GCS scores (GCS score ≤ 8, OR = 6.1; 95% CI = 1.15-32.34). By using an integrative index combining the 3 parameters together, the sensitivity and specificity to predict extubation outcomes were 78.6% and 75.9%, respectively. The area under the receiver operating characteristic curve of the index was significantly higher than RSBI (0.84 vs 0.61, P = .026). Conclusion: The integrative index combining serum albumin, hemoglobin, and GCS scores could predict extubation outcomes better than RSBI in an adult MICU.

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 Semiquantitative Cough Strength Score for Predicting Reintubation After Planned Extubation

2015 ◽  
Vol 24 (6) ◽  
pp. e86-e90 ◽  
Author(s):  
Jun Duan ◽  
Lintong Zhou ◽  
Meiling Xiao ◽  
Jinhua Liu ◽  
Xiangmei Yang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Spontaneous Breathing ◽  
Operating Characteristic ◽  
Peak Flow ◽  
Characteristic Curve ◽  
Spontaneous Breathing Trial ◽  
Extubation Outcome ◽  
Cough Strength ◽  
Operating Characteristic Curve

Background Semiquantitative cough strength score (SCSS, graded 0–5) and cough peak flow (CPF) have been used to predict extubation outcome in patients in whom extubation is planned; however, the correlation of the 2 assessments is unclear. Methods In the intensive care unit of a university-affiliated hospital, 186 patients who were ready for extubation after a successful spontaneous breathing trial were enrolled in the study. Both SCSS and CPF were assessed before extubation. Reintubation was recorded 72 hours after extubation. Results Reintubation rate was 15.1% within 72 hours after planned extubation. Patients in whom extubation was successful had higher SCSSs than did reintubated patients (mean [SD], 3.2 [1.6] vs 2.2 [1.6], P = .002) and CPF (74.3 [40.0] vs 51.7 [29.4] L/min, P = .005). The SCSS showed a positive correlation with CPF (r = 0.69, P &lt; .001). Mean CPFs were 38.36 L/min, 39.51 L/min, 44.67 L/min, 57.54 L/min, 78.96 L/min, and 113.69 L/min in patients with SCSSs of 0, 1, 2, 3, 4, and 5, respectively. The discriminatory power for reintubation, evidenced by area under the receiver operating characteristic curve, was similar: 0.677 for SCSS and 0.678 for CPF (P = .97). As SCSS increased (from 0 to 1 to 2 to 3 to 4 to 5), the reintubation rate decreased (from 29.4% to 25.0% to 19.4% to 16.1% to 13.2% to 4.1%). Conclusions SCSS was convenient to measure at the bedside. It was positively correlated with CPF and had the same accuracy for predicting reintubation after planned extubation.

scholarly journals Frequent tracheal suctioning is associated with extubation failure in patients with successful spontaneous breathing trial: a single-center retrospective cohort study

2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Junpei Haruna ◽  
Hiroomi Tatsumi ◽  
Satoshi Kazuma ◽  
Aki Sasaki ◽  
Yoshiki Masuda
Keyword(s):  
Mechanical Ventilation ◽  
Risk Factor ◽  
Spontaneous Breathing ◽  
Retrospective Cohort ◽  
Spontaneous Breathing Trial ◽  
Extubation Failure ◽  
Prolonged Stay ◽  
Sputum Volume ◽  
Tracheal Suctioning ◽  
Admission Type

Abstract Background Extubation failure, i.e., reintubation in ventilated patients, is a well-known risk factor for mortality and prolonged stay in the intensive care unit (ICU). Although sputum volume is a risk factor, the frequency of tracheal suctioning has not been validated as a predictor of reintubation. We conducted this study to examine whether frequent tracheal suctioning is a risk factor for reintubation. Patients and methods We included adult patients who were intubated for > 72 h in the ICU and extubated after completion of spontaneous breathing trial (SBT). We compared the characteristics and weaning-related variables, including the frequency of tracheal suctioning between patients who required reintubation within 24 h after extubation and those who did not, and examined the factors responsible for reintubation. Results Of the 400 patients enrolled, reintubation was required in 51 (12.8%). The most common cause of reintubation was difficulty in sputum excretion (66.7%). There were significant differences in sex, proportion of patients with chronic kidney disease, pneumonia, ICU admission type, the length of mechanical ventilation, and ICU stay between patients requiring reintubation and those who did not. Multivariate analysis showed frequent tracheal suction (> once every 2 h) and the length of mechanical ventilation were independent factors for predicting reintubation. Conclusion We should examine the frequency of tracheal suctioning > once every 2 h in addition to the length of mechanical ventilation before deciding to extubate after completion of SBT in patients intubated for > 72 h in the ICU.

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.

Accuracy of a spontaneous breathing trial for extubation of neonates

2020 ◽  
pp. 1-8
Author(s):  
M. Fiatt ◽  
A.C. Bosio ◽  
D. Neves ◽  
R. Symanski da Cunha ◽  
L.T. Fonseca ◽  
...  
Keyword(s):  
Predictive Value ◽  
Spontaneous Breathing ◽  
Pressure Support ◽  
Spontaneous Breathing Trial ◽  
Invasive Mechanical Ventilation ◽  
Newborn Infants ◽  
Extubation Failure ◽  
Great Accuracy ◽  
Minimum Pressure ◽  
Persistent Arterial Duct

BACKGROUND: Prevalence of extubation failure in neonates may be up to 80%, but evidence to determine if a neonate is ready for extubation remains unclear. We aim to evaluate a spontaneous breathing trial accuracy with minimum pressure support to predict success in neonates’ extubation and identify variables related to failures. METHODS: This is a diagnostic accuracy study based on a cohort study in an intensive care unit with all eligible newborn infants subjected to invasive mechanical ventilation for at least 24 hours submitted to the trial for 10 minutes before extubations. The outcome was failures of extubations, considered if reintubation was needed until 72 hours. RESULTS: The incidence of failure was 14.7%among 170 extubations. There were 145 successful extubations; of these, 140 also passed the trial with a sensitivity of 96.5%(95%CI: 92.1–98.9). Of the 25 extubations that eventually failed, 16 failed the test with a specificity of 64.0%(95%CI: 42.5–82.0). The negative predictive value was 76.2%, and the positive predictive value was 94%. In stratifying by weight, the accuracy was >98.7%for neonates weighting >2500 g, but 72.5%for those weighing <1250 g. Extubation failures occurred more frequently in smaller (p = 0.01), preterm infants (p = 0.17), with longer ventilation time (p = 0.05), and having a hemodynamically significant persistent arterial duct (p = 0.01), compared with infants whose extubation was successful. CONCLUSION: The spontaneous breathing trial with minimum pressure support ventilation seems to predict extubation success with great accuracy in full-term and larger neonates.

scholarly journals Role of Serum B-type Natriuretic Peptide before and after 2hours of Spontaneous Breathing Trial among Patients under Mechanical Ventilation

2021 ◽  
Vol 8 (2) ◽  
pp. 125-129
Author(s):  
AKM Faizul Hoque ◽  
Manas Kanti Mazumder ◽  
Omma Hafsa Any ◽  
Sharna Moin ◽  
Rocky Das Gupta ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Characteristic Curve ◽  
Spontaneous Breathing Trial ◽  
Area Under The Curve ◽  
Before And After ◽  
Mechanical Ventilation Support ◽  
Study Population ◽  
Medical University ◽  
Weaning Outcome

Background: Weaning of a patient from mechanical ventilation is very important for the outcomes of the patients. Objective: The purpose of the study was to evaluate the serum level of BNP before and after 2hours of spontaneous breathing trial (SBT) among patients under mechanical ventilation. Methodology: This prospective cohort study was conducted in the Department of Anesthesia, Analgesia and Intensive Care Medicine at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh over a period of 2 years. Study population was selected for weaning from mechanical ventilation support for the first time in the age group of more than 18 years with both sexes. Plasma BNP level of all patients was measured before and after 2 hours of spontaneous breathing trial. Results: A total number of 30 patients were recruited for this study. One-third (33.3%) of the patients failed on SBT. The mean percent changes of BNP (pg/ml) during 2-h of SBT in weaning success and failure groups were 38.41±9.379 and 59.51±2.940 respectively (p=0.01). The receiver-operating characteristic curve analysis for BNP as a predictor of weaning outcome, showed that the area under the curve (AUC) was 0.89. Conclusion: In conclusion BNP is currently a good predictor of different cardiac diseases. Journal of Current and Advance Medical Research, July 2021;8(2):125-129

scholarly journals Effects of Noninvasive Versus Invasive Mechanical Ventilation on Sleep in the Intensive Care Unit – A Pilot Study

2020 ◽  
pp. 127-136
Author(s):  
Aylin Ozsancak Ugurlu ◽  
Karthik Jothianandan ◽  
Carolyn M. D'Ambrosio ◽  
Samy Sidhom ◽  
Eric Garpestad ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Total Sleep Time ◽  
Invasive Mechanical Ventilation ◽  
Environmental Parameters ◽  
Sleep Time ◽  
Mask Type ◽  
Medical Intensive Care ◽  
Stage 1

Rationale: Use of noninvasive ventilation (NIV) has increased in intensive care units, but sleep during NIV has received little attention. The authors surmised that due to frequent air leaks and mask discomfort, patients receiving NIV would manifest poorer sleep quality than those receiving invasive mechanical ventilation (INV). Methods: A prospective observational study on patients receiving NIV or INV for respiratory failure in a medical intensive care unit or coronary care unit. Patients were monitored by polysomnography for 24 hours with simultaneous collection of data on ventilator and environmental parameters. Results: Eight subjects in each group were studied. Mean total sleep time was 7.29 +1.78 hours (range: 0.57–13.82) in the NIV versus 11.74 +0.65 hours (8.95–15.19) in the INV group (p=0.034). Sleep efficiency was lower in NIV than INV group (30.4% versus 53.3%, respectively; p=0.013). The NIV group had lighter sleep than the INV group (mean % of Stage 1: 36.9% versus 17.2% of total sleep time, respectively; p=0.000), whereas no significant differences were found for other stages. Median total arousal and awakening indexes were higher in the NIV group (16.8/hour versus 4.4/hour and 5.3/hour versus 2.1/hour, respectively; p=0.005), as well as spontaneous arousals and awakenings (p=0.006 and p=0.005, respectively). Sedation was provided mostly by intermittent bolus in the NIV group whereas often by infusion in the INV group. Conclusion: Compared to INV, NIV in critically ill patients was associated with poorer quality and quantity of sleep. Future studies should determine whether adjustments in ventilator settings, mask type or fit, or use of sedation/analgaesia can improve sleep in patients receiving NIV.

Weaning failure in critical illness

2016 ◽  
Author(s):  
Annalisa Carlucci ◽  
Paolo Navalesi
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Respiratory Muscle ◽  
Prolonged Mechanical Ventilation ◽  
Spontaneous Breathing Trial ◽  
Extubation Failure ◽  
High Morbidity ◽  
Weaning Failure ◽  
Generating Capacity ◽  
The One

Weaning failure has been defined as failure to discontinue mechanical ventilation, as assessed by the spontaneous breathing trial, or need for re-intubation after extubation, so-called extubation failure. Both events represent major clinical and economic burdens, and are associated with high morbidity and mortality. The most important mechanism leading to discontinuation failure is an unfavourable balance between respiratory muscle capacity and the load they must face. Beyond specific diseases leading to loss of muscle force-generating capacity, other factors may impair respiratory muscle function, including prolonged mechanical ventilation, sedation, and ICU-acquired neuromuscular dysfunction, potentially consequent to multiple factors. The load depends on the mechanical properties of the respiratory system. An increased load is consequent to any condition leading to increased resistance, reduced compliance, and/or occurrence of intrinsic positive-end-expiratory pressure. Noteworthy, the load can significantly increase throughout the spontaneous breathing trial. Cardiac, cerebral, and neuropsychiatric disorders are also causes of discontinuation failure. Extubation failure may depend, on the one hand, on a deteriorated force-load balance occurring after removal of the endotracheal tube and, on the other hand, on specific problems. Careful patient evaluation, avoidance and treatment of all the potential determinants of failure are crucial to achieve successful discontinuation and extubation.

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