Weaning from Mechanical Ventilation and Post-Extubation Failure

2011 ◽  
Vol 12 (1) ◽  
pp. 27-31
Author(s):  
Paola Pierucci ◽  
Annalisa Carlucci ◽  
Annia Schreiber ◽  
Stefano Nava
Keyword(s):  
Mechanical Ventilation ◽  
Extubation Failure ◽  
Weaning From Mechanical Ventilation

scholarly journals Weaning from Mechanical Ventilation

2021 ◽  
Author(s):  
Liran Statlender ◽  
Pierre Singer
Keyword(s):  
Mechanical Ventilation ◽  
Palliative Care ◽  
Clinical Condition ◽  
Extubation Failure ◽  
Weaning From Mechanical Ventilation ◽  
Proper Method ◽  
Methods And Techniques ◽  
Rehabilitation Ward

Weaning off mechanical ventilation (MV) is a process that ultimately ends with a patient’s liberation from the ventilator. As extubation failure worsens prognosis, every effort should be made to safely extubate the patient when the clinical condition allows it. There are several methods and techniques to assess whether a patient is ready for weaning. The clinician should choose the proper method for each patient to minimalize the risk of extubation failure. When liberation from MV is not possible, tracheostomy and transferring the patient to a long-term rehabilitation ward may be required. If this is not feasible, palliative care should be considered.

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.

scholarly journals The relationship between maximal expiratory pressure values and critical outcomes in mechanically ventilated patients: a post hoc analysis of an observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yann Combret ◽  
Guillaume Prieur ◽  
Roger Hilfiker ◽  
Francis-Edouard Gravier ◽  
Pauline Smondack ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Univariate Analysis ◽  
Premature Death ◽  
Extubation Failure ◽  
Short Term ◽  
Expiratory Muscle ◽  
Maximal Expiratory Pressure ◽  
The Impact ◽  
The Relationship

Abstract Background Little interest has been paid to expiratory muscle strength, and the impact of expiratory muscle weakness on critical outcomes is not known. Very few studies assessed the relationship between maximal expiratory pressure (MEP) and critical outcomes. The aim of this study was to investigate the relationship between MEP and critical outcomes. Methods This work was a secondary analysis of a prospective, observational study of adult patients who required mechanical ventilation for ≥ 24 h in an 18-bed ICU. MEP was assessed before extubation after a successful, spontaneous breathing trial. The relationships between MEP and extubation failure, and short-term (30 days) mortality, were investigated. Univariate logistic regressions were computed to investigate the relationship between MEP values and critical outcomes. Two multivariate analyses, with and without maximal inspiratory pressure (MIP), both adjusted using principal component analysis, were undertaken. Unadjusted and adjusted ROC curves were computed to compare the respective ability of MEP, MIP and the combination of both measures to discriminate patients with and without extubation failure or premature death. Results One hundred and twenty-four patients were included. Median age was 66 years (IQR 18) and median mechanical ventilation duration was 7 days (IQR 6). Extubation failure rate was 15% (18/124 patients) and the rate for 30-day mortality was 11% (14/124 patient). Higher MEP values were significantly associated with a lower risk of extubation failure in the univariate analysis [OR 0.96 95% CI (0.93–0.98)], but not with short-term mortality. MEP was independently linked with extubation failure when MIP was not included in the multivariate model, but not when it was included, despite limited collinearity between these variables. This study was not able to differentiate the respective abilities of MEP, MIP, and their combination to discriminate patients with extubation failure or premature death (adjusted AUC for the combination of MEP and MIP: 0.825 and 0.650 for extubation failure and premature death, respectively). Conclusions MEP is related to extubation failure. But, the results did not support its use as a substitute for MIP, since the relationship between MEP and critical outcomes was no longer significant when MIP was included. The use of MIP and MEP measurements combined did not reach higher discriminative capacities for critical outcomes that MEP or MIP alone. Trial Registration This study was retrospectively registered at https://clinicaltrials.gov/ct2/show/NCT02363231?cond=NCT02363231&draw=2&rank=1 (NCT02363231) in 13 February 2015

Sign in / Sign up

Export Citation Format

Share Document