scholarly journals Handgrip strength cutoff value predicting successful extubation in mechanically ventilated patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258971
Author(s):  
Narongkorn Saiphoklang ◽  
Nattawadee Mokkongphai
Keyword(s):  
Prospective Study ◽  
Roc Curve ◽  
Handgrip Strength ◽  
Spontaneous Breathing Trial ◽  
Predictive Tool ◽  
Cutoff Value ◽  
Rapid Shallow Breathing Index ◽  
Weaning Failure ◽  
A Prospective Study ◽  
Successful Extubation

Background Handgrip strength (HGS) is an alternative tool to evaluate respiratory muscle function. HGS cutoff value indicating extubation success or failure has not been investigated. This study aimed to determine HGS cutoff value to predict successful extubation. Methods A prospective study was conducted. Patients requiring intubated mechanical ventilation with intubation ≥ 48 hours in medical wards were recruited. HGS test was performed at 10 minutes before and 30 minutes after spontaneous breathing trial (SBT). Rapid shallow breathing index (RSBI) was measured at 10 minutes before SBT. Results Ninety-three patients (58% men) were included. Mean age was 71.6 ± 15.2 years. Weaning failure rate was 6.5%. The area under the ROC curve of 0.84 for the best HGS cutoff value at 10 minutes before SBT was 12.7 kg, with 75.9% sensitivity and 83.3% specificity (P = 0.005). The best HSG cutoff value at 30 minutes after SBT was 14.9 kg, with the area under the ROC curve of 0.82, with 58.6% sensitivity and 83.3% specificity (P = 0.009). The best RSBI cutoff value was 43.5 breaths/min/L, with the area under the ROC curve of 0.46, 33.3% sensitivity and 66.6% specificity (P = 0.737). Conclusions HGS may be a predictive tool to guide extubation with better sensitivity and specificity than RSBI. A prospective study is needed to verify HGS test as adjunctive to RSBI in ventilator weaning protocol.

scholarly journals Correlation between Handgrip Strength and Rapid Shallow Breathing Index for Assessment of Weaning from Mechanical Ventilation

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Narongkorn Saiphoklang ◽  
Thanapon Keawon
Keyword(s):  
Mechanical Ventilation ◽  
Prospective Study ◽  
Handgrip Strength ◽  
Apache Ii Score ◽  
Weaning From Mechanical Ventilation ◽  
Rapid Shallow Breathing Index ◽  
Weaning Failure ◽  
Shallow Breathing ◽  
A Prospective Study ◽  
Rapid Shallow Breathing

Background. Assessment of weaning from mechanical ventilation (MV) is an important process. Rapid shallow breathing index (RSBI) is a standard tool to evaluate a patient’s readiness before the spontaneous breathing trial (SBT). Handgrip strength (HGS) is an alternative method for assessment of respiratory muscle strength. Relationship between HGS and RSBI has not been explored. This study aimed to determine the correlation between HGS and RSBI to predict successful extubation in mechanically ventilated patients. Methods. A prospective study was conducted in screened 120 patients requiring MV with tracheal intubation >48 h. HGS was performed at 48 h after intubation, 10 min before and 30 min after SBT, and 1 h after extubation. RSBI was performed at 10 min before SBT. Results. A total of 93 patients (58% men) were included in the final analysis. Mean age was 71.6 ± 15.2 years. Patients admitted in general medical wards were 84.9%. APACHE II score was 13.5 ± 4.7. Most patients were intubated from pneumonia (39.8%). Weaning failure was 6.5%. The main result shows that HGS was negatively correlated with RSBI (regression coefficient −0.571, P < 0.001 ). The equation for predicting RSBI, derived from the linear regression model, was predicted RSBI (breaths/min/L) = 39.285 + (age ∗ 0.138)–(HGS ∗ 0.571). Conclusions. HGS had significantly negative correlation with RSBI for assessment of weaning from MV. A prospective study of the HGS cutoff value is needed to investigate the difference between patients who succeeded and those who failed extubation. This trial is registered with TCTR20180323004.

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 ROLE OF TLC NLR & SERUM CREATININE IN DIAGNOSING ACUTE APPENDICITIS: A PROSPECTIVE STUDY IN A TERTIARY CARE CENTRE

2021 ◽  
pp. 1-3
Author(s):  
Madhu B S ◽  
Shraddha Shenoy
Keyword(s):  
Acute Appendicitis ◽  
Serum Creatinine ◽  
Prospective Study ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Cutoff Value ◽  
A Prospective Study ◽  
Complicated Acute Appendicitis

Aim- To assess the role of TLC and NLR and serum creatinine in diagnosing acute appendicitis. Background-Acute appendicitis being the most common surgical emergency globally can lead to varied consequences if not detected and treated accurately. Early and precise biochemical detectors affect the severity of acute appendicitis. Materials and methodology- A prospective study was conducted in K R Hospital, Mysore from 2019-2020. All cases of acute appendicitis during this period were assessed for severity. TLC, NLR and serum creatinine were assessed and correlated with severity of acute appendicitis. Results- A total of 96 patients were included in the study, 72 patients had SAA and 24 had CAA. This was classified in accordance to the cut off values. TC cut off point was 15,050 cells/cumm ,Sn 91.7 %, Sp 74.6%. The NLR cutoff value was 4.56, Sn of 83.3%, Sp of 66.2%. The cutoff value for neutrophil count was 77.6%, Sn 91.7% , Sp 71.18%. The cutoff value for lymphocyte count was 18.2%, Sn was 91.7%, Sp 65.8%. The cutoff value of creatinine was 0.73, Sn of 83.3%, Sp 80.03%. Conclusion- TC, TLC, NLR and Serum creatinine combinedly help distinguishing between the simple acute appendicitis and complicated acute appendicitis and is a very economical measure for the prediction

scholarly journals A prospective study to assess the use of preoperative neutrophil to lymphocyte ratio as a predictor of severe cholecystitis

2021 ◽  
Vol 8 (3) ◽  
pp. 962
Author(s):  
N. Siva Durgesh ◽  
V. Viswa Teja
Keyword(s):  
High Risk ◽  
Prospective Study ◽  
Acute Cholecystitis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Medical Sciences ◽  
Cutoff Value ◽  
Lymphocyte Ratio ◽  
Study Results ◽  
A Prospective Study

Background: Cholecystitis can be divided into simple and severe cholecystitis. Untreated simple cholecystitis resolves within 7–10 days if it does not progress to more severe cholecystitis. Aims and objectives were to evaluate whether neutrophil-to-lymphocyte ratio can differentiate between simple cholecystitis and severe cholecystitis. To evaluate role of NLR as a prognostic indicator.Methods: The source of data for our study will be patients admitted in the department of general surgery diagnosed with acute cholecystitis in Konaseema Institute of medical sciences and research foundation, Amalapuram. All patients between 15 to 70 years of age with a clinical diagnosis of acute cholecystitis confirmed with histopathology study. Results: With an NLR value of 4.35, the sensitivity and specificity were 67% and 87%, respectively. Therefore, we considered 4.35 as the cutoff value, and divided the patient population into two groups: those with preoperative NLR values below 4.35 (n=50) and those with values equal to or greater than 4.35 (n=15). 53.33% of higher NLR group patients had severe cholecystitis compared to only 8 % of patients in lower NLR group (p<0.05).  Conclusions: It was seen that the patients with cholecystitis can be divided into low risk (NLR<4.35) and high risk (NLR≥4.35) groups for severe cholecystitis as per the NLR value at admission.

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.

The Handgrip Strength and Risk of Depression Symptoms: A Prospective Study and Meta-Analysis

2019 ◽  
Author(s):  
Yuting Ying ◽  
Kailiang Liu ◽  
Xiuxia Huang ◽  
Jun Ma ◽  
Haiyan Chen ◽  
...  
Keyword(s):  
Prospective Study ◽  
Handgrip Strength ◽  
Meta Analysis ◽  
Depression Symptoms ◽  
A Prospective Study

scholarly journals Ultrasound-Guided Preload Indices during Different Weaning Protocols of Mechanically Ventilated Patients and its Impact on Weaning Induced Cardiac Dysfunction

2021 ◽  
Vol 9 (B) ◽  
pp. 1370-1380
Author(s):  
Dina Zeid ◽  
Walid Ahmed ◽  
Randa Soliman ◽  
Abdou Alazab ◽  
Ahmed Samir Elsawy
Keyword(s):  
Mechanical Ventilation ◽  
Prospective Observational Study ◽  
Spontaneous Breathing Trial ◽  
Vena Cava ◽  
Left Ventricular ◽  
Cutoff Value ◽  
Mechanically Ventilated ◽  
Collapsibility Index ◽  
Echocardiographic Evaluation ◽  
Weaning Failure

BACKGROUND: Elevation of the left ventricular (LV) filling pressure can occur during weaning of mechanical ventilation due to increase in LV preload and/or changes in LV compliance and LV afterload. AIM: The aim of the study was to evaluate respiratory changes in internal jugular vein and inferior vena cava during weaning from mechanical ventilation. METHODS: Prospective observational study conducted on 80 consecutive patients. Patients were divided randomly into two groups who met the readiness criteria to start spontaneous breathing trial (SBT) either on pressure support ventilation (PS/CPAP) for 30 min or T-piece for 120 min. Weaning failure was defined as a failed SBT or reintubation within 48 h. Echocardiographic evaluation was done on assisted controlled ventilation and at the end of SBT for preload assessment. RESULTS: Mitral Septal E/E’ Cutoff value ≥6.1 with sensitivity 81% and specificity 84.2%, and AUC 0.73 for predicting weaning failure. IVC distensibility index on CPAP cutoff value ≥66.5% with sensitivity 100% and specificity 68.4%, and AUC 0.85. In Group II, Mitral Septal E/E’ Cut off value ≥5.8 with sensitivity 83% and specificity 90.9%, AUC 0.83, IVC collapsibility index Cut off value ≥45.5% with sensitivity 72% and specificity 86%, AUC 0.73. CONCLUSION: Mitral Septal E/E’ could predict weaning-induced diastolic dysfunction. IVC plays an important role in predicting weaning failure.

The immature platelet fraction, a predictive tool for early recovery from dengue-related thrombocytopenia: a prospective study

2021 ◽  
Author(s):  
Visula Abeysuriya ◽  
Suranjith L Seneviratne ◽  
Primesh de Mel ◽  
Choong Shi Hui Clarice ◽  
Chandima de Mel ◽  
...  
Keyword(s):  
Prospective Study ◽  
Medical Records ◽  
Severe Dengue ◽  
Early Recovery ◽  
Predictive Tool ◽  
Platelet Recovery ◽  
Immature Platelet Fraction ◽  
Automated Hematology Analyzer ◽  
Structural Antigen ◽  
A Prospective Study

Abstract Background There is a paucity of predictive factors for early recovery from thrombocytopenia related to dengue. The immature platelet fraction (IPF%) is reflective of megakaryopoiesis and may correlate with recovery from dengue-related thrombocytopenia. Our objective was to assess the predictive value of IPF% on days 2 and 3 of illness for recovery from dengue-related thrombocytopenia. Methods A prospective study was conducted among patients with dengue admitted to our institution (Nawaloka Hospital PLC) from December 2019 to October 2020. Dengue was diagnosed based on positive non-structural antigen 1 or IgM. IPF% data were extracted from the Sysmex-XN-1000 automated hematology analyzer. Clinical data were obtained from electronic medical records. Statistical analyses were performed using SPSS version 20. Results We included 240 patients. An IPF% on day 2 of illness of &gt;7.15% had a sensitivity of 80.0% and specificity of 70.4% for prediction of platelet recovery (defined as platelet count ≥60×109/L) on day 7 of illness. An IPF% of &gt;7.25% on day 3 of illness had a sensitivity of 88.9% and specificity of 47.1% for predicting platelet recovery &gt;60×109/L on day 8 of illness. The IPF% was significantly lower in patients with severe dengue. Platelet recovery was observed within 48 h after the peak IPF% was reached, regardless of severity. Conclusion We propose that IPF% values on days 2 and 3 of illness are a promising predictive tool for early recovery from dengue-related thrombocytopenia.

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