scholarly journals CRITERIA FOR SUCCESSFUL WEANING FROM MECHANICAL VENTILATION IN CHILDREN

ScienceRise ◽  
2020 ◽  
Vol 4 ◽  
pp. 53-58
Author(s):  
Olha Filyk
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Respiratory Muscle ◽  
Maximum Amplitude ◽  
Load Level ◽  
Routine Practice ◽  
Weaning From Mechanical Ventilation ◽  
Rapid Shallow Breathing Index ◽  
Difficult Weaning ◽  
Successful Weaning

The aim of the research was to establish criteria for successful weaning from mechanical ventilation in children based on analysis of Paediatric rapid shallow breathing index, maximum amplitude of diaphragm movements, diaphragm thickening fraction and pressure support (PS), which ensure minimal respiratory muscle load, level of consciousness which ensure minimal respiratory muscle load and presence of cough and swallowing reflexes and previous unsuccessful attempts of weaning. Investigated problem: there is no consensus on the basic physiological parameters for successful extubation that have to be achieved during weaning from mechanical ventilation in children due to variability in size and degree of maturity of lungs and patients’ comorbidities. It leads to the lack of clinical justification for the routine practice of weaning in children. The main scientific results: We have established a list of causes of unsuccessful weaning depending on the function of the diaphragm in children with different types of respiratory failure. We have clarified and supplemented the list of reasons for unsuccessful weaning from mechanical ventilation depending on nutritional status and level of serum electrolytes in children. We have identified and supplemented the list of reasons for unsuccessful weaning from mechanical ventilation depending on the disorders of neurological status in children. We have supplemented the algorithm for predicting difficult weaning from mechanical ventilation in children. The area of practical use of the research results: the obtained results have to increase the rate of successful weaning in children with acute respiratory failure in pediatric intensive care units.

scholarly journals Application of bedside ultrasound in predicting the outcome of weaning from mechanical ventilation in elderly patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shigang Li ◽  
Zhe Chen ◽  
Weifeng Yan
Keyword(s):  
Mechanical Ventilation ◽  
Elderly Patients ◽  
Extubation Failure ◽  
Bedside Ultrasound ◽  
Weaning From Mechanical Ventilation ◽  
Rapid Shallow Breathing Index ◽  
Diaphragm Function ◽  
Successful Weaning ◽  
Shallow Breathing ◽  
Weaning Outcome

Abstract Background With the increased ageing of society, more and more elderly people are admitted to the intensive care unit, How to accurately predict whether elderly patients can successfully wean from the ventilator is more complicated. Diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF) were measured by bedside ultrasound to assess diaphragm function. The lung ultrasound score (LUS) and the rapid shallow breathing index (RBSI) were used as indices of diaphragm function to predict the outcome of weaning from mechanical ventilation. The aim of this study was to examine the clinical utility of these parameters in predicting extubation success. Methods This prospective study included 101 consecutive elderly patients undergoing a trial of extubation in the ICU of Haidian Hospital between June 2017 and July 2020. Patients were divided into the successful weaning group (n = 69) and the failed weaning group (n = 32). Baseline characteristics, including RSBI, were recorded. Measurements of DE, DTF and LUS were made using ultrasound within 24 h before extubation. Results Median DE was greater in patients with extubation success than in those with extubation failure (1.64 cm vs. 0.78 cm, p = 0.001). Patients with extubation success had a greater DTF than those with extubation failure (49.48% vs. 27.85%, p = 0.001). The areas under the receiver operating curves for the RSBI, LUS, DE and DFT were 0.680, 0.764, 0.831 and 0.881, respectively. The best cut-off values for predicting successful weaning were DTF ≥ 30%, DE ≥ 1.3 cm, LUS ≤ 11, and RSBI ≤ 102. The specificity of DTF (84%) in predicting weaning outcome was higher than that of RBSI (53%), that of LUS (55%), and that of DE (62%). The sensitivity of DTF (94%) was greater than that of RBSI (85%), that of LUS (71%), and that of DE (65%). The combination of RSBI, LUS, DE, and DTF showed the highest AUC (AUC = 0.919), with a sensitivity of 96% and a specificity of 89%. Conclusions DTF has higher sensitivity and specificity for the prediction of successful weaning in elderly patients than the other parameters examined. The combination of RSBI, LUS, DE and DFT performed well in predicting weaning outcome. This has potentially important clinical application and merits further evaluation.

The Role of Diaphragmatic Rapid Shallow Breathing Index and Maximum Inspiratory Pressure in Predicting Outcome of Weaning From Mechanical Ventilation

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Galal Adel Mohamed Abd Al Rahem Al Kadi ◽  
Raham Hasan Mostafa ◽  
Omnia Mohamed Mostafa Helwa ◽  
Ahmed Fathy Ahmed Abd-Allah
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Weaning From Mechanical Ventilation ◽  
Mechanically Ventilated ◽  
Maximum Inspiratory Pressure ◽  
Rapid Shallow Breathing Index ◽  
Inspiratory Muscles ◽  
Shallow Breathing ◽  
Weaning Outcome ◽  
Rapid Shallow Breathing

Abstract Background Mechanical ventilation is the defining event of intensive care unit (ICU) management. It is a lifesaving intervention in patients with acute respiratory failure and whose spontaneous ventilation is inadequate for subsequent development of life threatening hypoxia and/or respiratory acidosis. Many physicians simply look at the patient’s ability to tolerate a spontaneous breathing trial (SBT) without distress through the respiratory rate (RR) and TV during the SBT. The RR/TV ratio, i.e., the rapid shallow breathing index (RSBI), one of the most used clinical indices to predict weaning outcome, reflects the balance between mechanical load posed on the inspiratory muscles and the inspiratory muscles ability to face it during the weaning attempt. However, RSBI was found to have both variable sensitivity and specificity for predicting weaning outcome. Although the diaphragm plays a fundamental role in generating TV in healthy subjects, if the diaphragmatic efficiency is impaired the accessory inspiratory muscles mild contribute to the ventilation for a limited period of time, for example during a SBT. However, since they are by far less efficient and more fatigable than the diaphragm, their exhaustion was likely lead to weaning failure in subsequent hours. Hence, the contribution of the accessory muscles to TV could compromise the diagnostic accuracy of the RSBI by masking the underlying diaphragmatic dysfunction. Aim of the Work To assess the accuracy of Diaphragmatic Rapid shallow breathing index and Maximum inspiratory pressure in predicting the outcome of weaning from mechanical ventilation. Patients and Methods The study was conducted at Ain Shams University Hospitals over 6 months on Patients who were mechanically ventilated for more than 48 hrs who were ready for weaning. Inclusion Criteria Patients intubated & mechanically ventilated for more than 48 hrs. Patients at their first SBT.Patients with adequate cough reflex. Patients fulfilling criteria of readiness for weaning from mechanical ventilation after resolution of cause of respiratory failure: Patients with score ranging between -1 and +1 on the Richmond Agitation and sedation scale (RASS). Exclusion criteria Age < 18 yrs. Patients with thoracotomy, pneumothorax, or pneumomediastinum. Patients with presence of flail chest or rib fractures. Patients with neuromuscular disease. Use of muscle-paralyzing agents within 48 hours before the study. History or new detection of paralysis or paradoxical movement of a single hemi diaphragm on diaphragmatic ultrasonography. Pregnant females. Unconscious noncooperative patients. Patients with intra-abdominal hypertension, Long term steroid therapy. Results I- Distribution of the studied patients regarding final outcome. II- Demographic data. III. Causes of MV. IV- Days on MV. V- Patients’ data and characteristics before start of weaning trial. VI- SBT Ventilator Breathing pattern after 30 min. VII- Study predictors. Conclusion D-RSBI is a new and promising tool that is superior to the traditional RSBI in predicting weaning outcome also MIP provides appreciated data with greater accuracy to assess inspiratory muscle strength and predicting weaning success in mechanically ventilated patients. Recommendations We could recommend the measurement of MIP and DRSBI as weaning predictors should be an integral part of evaluation of patients plan for weaning from MV. All intensivists should be acquitted with the use of U/S in the evaluation of diaphragmatic function.

Lung Ultrasound to Monitor Disease Severity and Aid Prognostication in COVID-19 Pneumonia: A Retrospective Analysis of Serial Lung Ultrasound Assessments

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 109-116
Author(s):  
Matthew Llewelyn Gibbins ◽  
Quentin Otto ◽  
Paul Adrian Clarke ◽  
Stefan Gurney
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Analysis ◽  
Disease Severity ◽  
Scoring System ◽  
Lung Ultrasound ◽  
Weaning From Mechanical Ventilation ◽  
Icu Discharge ◽  
Successful Weaning ◽  
Ultrasound Assessment ◽  
Disease Free

Background: The aim of this retrospective analysis was to assess if serial lung ultrasound assessments in patients with COVID-19 pneumonia, including a novel simplified scoring system, correlate with PaO2:FiO2 ratio, as a marker of disease severity, and patient outcomes. Methods: Patients treated for COVID-19 pneumonia in a tertiary intensive care unit who had a lung ultrasound assessment were included. Standardised assessments of anterior and lateral lung regions were prospectively recorded. A validated lung ultrasound score-of-aeration and a simplified scoring system based on the number of disease-free lung regions were correlated with: PaO2:FiO2 ratio,  successful weaning from mechanical ventilation, and status (alive or dead) at discharge.  MedCalc© statistical software was used for statistical analysis. Results: 28 patients (109 assessments) were included. Correlation was seen between score-of-aeration and PaO2:FiO2 ratio (r = -0.61, p<0.0001) and between the simplified scoring system and PaO2:FiO2 ratio (r = 0.52 p<0.0001). Achieving a score-of-aeration of ≤9/24 or ≥2 disease-free regions was associated with successful weaning from mechanical ventilation and survival to ICU discharge (accuracy of 94% and 97% respectively). Conclusion: Retrospective analysis from this small cohort of patients demonstrates that scores-of-aeration and a simplified scoring system based on the number of disease-free antero-lateral regions from serial LUS assessments correlate with PaO2:FiO2 ratio as a marker of disease severity in patients with COVID-19 pneumonia. In addition, lung ultrasound may help identify patients who will have favourable outcomes. 

scholarly journals Respiratory Muscle Effort during Expiration in Successful and Failed Weaning from Mechanical Ventilation

2018 ◽  
Vol 129 (3) ◽  
pp. 490-501 ◽  
Author(s):  
Jonne Doorduin ◽  
Lisanne H. Roesthuis ◽  
Diana Jansen ◽  
Johannes G. van der Hoeven ◽  
Hieronymus W. H. van Hees ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Electrical Activity ◽  
Muscle Activity ◽  
Respiratory Muscle ◽  
Weaning From Mechanical Ventilation ◽  
Expiratory Muscle ◽  
Diaphragm Electrical Activity ◽  
Gastric Pressure ◽  
Weaning Failure ◽  
Expiratory Muscles

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Respiratory muscle weakness in critically ill patients is associated with difficulty in weaning from mechanical ventilation. Previous studies have mainly focused on inspiratory muscle activity during weaning; expiratory muscle activity is less well understood. The current study describes expiratory muscle activity during weaning, including tonic diaphragm activity. The authors hypothesized that expiratory muscle effort is greater in patients who fail to wean compared to those who wean successfully. Methods Twenty adult patients receiving mechanical ventilation (more than 72 h) performed a spontaneous breathing trial. Tidal volume, transdiaphragmatic pressure, diaphragm electrical activity, and diaphragm neuromechanical efficiency were calculated on a breath-by-breath basis. Inspiratory (and expiratory) muscle efforts were calculated as the inspiratory esophageal (and expiratory gastric) pressure–time products, respectively. Results Nine patients failed weaning. The contribution of the expiratory muscles to total respiratory muscle effort increased in the “failure” group from 13 ± 9% at onset to 24 ± 10% at the end of the breathing trial (P = 0.047); there was no increase in the “success” group. Diaphragm electrical activity (expressed as the percentage of inspiratory peak) was low at end expiration (failure, 3 ± 2%; success, 4 ± 6%) and equal between groups during the entire expiratory phase (P = 0.407). Diaphragm neuromechanical efficiency was lower in the failure versus success groups (0.38 ± 0.16 vs. 0.71 ± 0.36 cm H2O/μV; P = 0.054). Conclusions Weaning failure (vs. success) is associated with increased effort of the expiratory muscles and impaired neuromechanical efficiency of the diaphragm but no difference in tonic activity of the diaphragm.

scholarly journals Neuromuscular dysfunction associated with delayed weaning from mechanical ventilation in patients with respiratory failure

2012 ◽  
Vol 48 (3) ◽  
pp. 223-232 ◽  
Author(s):  
Yehia Khalil ◽  
Emad El Din Mustafa ◽  
Ahmed Youssef ◽  
Mohamed Hassan Imam ◽  
Amni Fathy El Behiry
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Weaning From Mechanical Ventilation ◽  
Neuromuscular Dysfunction
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