STUDY OBJECTIVES: To determine if minute ventilation (E) measured as a trend following the final weaning trial prior to extubation may identify patients ready for extubation and be useful as a predictive measure of extubation outcome. DESIGN: Prospective observational study. SETTING: Community hospital medical/surgical ICU. PATIENTS: Sixty-nine patients receiving mechanical ventilation enrolled in an ICU weaning protocol who underwent planned extubation during 6 months of prospective evaluation. The failed extubation group included patients reintubated within 7 days. Patients were excluded if they received ventilation by noninvasive mask, bilevel positive airway pressure, tracheostomy, or were self-extubated. INTERVENTIONS: Patients tolerating a spontaneous breathing trial (SBT) and ready for planned extubation were placed back on their pre-SBT ventilator settings for up to 25 min, during which respiratory parameters were recorded. Respiratory parameters (respiratory rate, tidal volume, E, rapid shallow breathing index [f/VT]) were obtained at three time points: baseline (pre-SBT), posttrial (immediate conclusion of SBT), and recovery (return to baseline). Patients were assumed to recover when E decreased to 110% of the predetermined baseline. MEASUREMENTS AND RESULTS: Fifty-nine patients were successfully extubated, and 10 patients required reintubation after 2.5 +/- 2.6 days (mean +/- SD). Both groups were similar in age, comorbid status, primary diagnosis, APACHE (acute physiology and chronic health evaluation) II score, mode of weaning, and SBT length (p > 0.1). Respiratory parameters measured were similar at all three time points studied (p > 0.1). E recovery time of successful extubations was significantly shorter than failed extubations (3.6 +/- 2.7 min vs 9.6 +/- 5.8 min, p < 0.011). Multiple logistic regression adjusted for age, sex, and severity of illness revealed that E recovery time was an independent predictor of extubation outcome (p < 0.01). The area under the receiver operating characteristic curve for E recovery time (0.85 +/- 0.07) was larger than that for baseline E, posttrial E, posttrial f/VT, or PaCO(2). CONCLUSIONS: E recovery time is an easy-to-measure parameter that may assist in determining respiratory reserve. Preliminary data demonstrates that it may be a useful adjunct in the decision to discontinue mechanical ventilation.
STUDY OBJECTIVES: To determine if minute ventilation (E) measured as a trend following the final weaning trial prior to extubation may identify patients ready for extubation and be useful as a predictive measure of extubation outcome. DESIGN: Prospective observational study. SETTING: Community hospital medical/surgical ICU. PATIENTS: Sixty-nine patients receiving mechanical ventilation enrolled in an ICU weaning protocol who underwent planned extubation during 6 months of prospective evaluation. The failed extubation group included patients reintubated within 7 days. Patients were excluded if they received ventilation by noninvasive mask, bilevel positive airway pressure, tracheostomy, or were self-extubated. INTERVENTIONS:Patients tolerating a spontaneous breathing trial (SBT) and ready for planned extubation were placed back on their pre-SBT ventilator settings for up to 25 min, during which respiratory parameters were recorded. Respiratory parameters (respiratory rate, tidal volume, E, rapid shallow breathing index [f/VT]) were obtained at three time points: baseline (pre-SBT), posttrial (immediate conclusion of SBT), and recovery (return to baseline). Patients were assumed to recover when E decreased to 110% of the predetermined baseline. MEASUREMENTS AND RESULTS: Fifty-nine patients were successfully extubated, and 10 patients required reintubation after 2.5 +/- 2.6 days (mean +/- SD). Both groups were similar in age, comorbid status, primary diagnosis, APACHE (acute physiology and chronic health evaluation) II score, mode of weaning, and SBT length (p > 0.1). Respiratory parameters measured were similar at all three time points studied (p > 0.1). E recovery time of successful extubations was significantly shorter than failed extubations (3.6 +/- 2.7 min vs 9.6 +/- 5.8 min, p < 0.011). Multiple logistic regression adjusted for age, sex, and severity of illness revealed that E recovery time was an independent predictor of extubation outcome (p < 0.01). The area under the receiver operating characteristic curve for E recovery time (0.85 +/- 0.07) was larger than that for baseline E, posttrial E, posttrial f/VT, or PaCO(2). CONCLUSIONS: E recovery time is an easy-to-measure parameter that may assist in determining respiratory reserve. Preliminary data demonstrates that it may be a useful adjunct in the decision to discontinue mechanical ventilation.
Authors: Leopoldo N Segal; Erwin Oei; Beno W Oppenheimer; Roberta M Goldring; Rami T Bustami; Salvatore Ruggiero; Kenneth I Berger; Stanley B Fiel Journal: Intensive Care Med Date: 2009-11-28 Impact factor: 17.440
Authors: M Mar Fernandez; Alejandro González-Castro; Monica Magret; M Teresa Bouza; Marcos Ibañez; Carolina García; Begoña Balerdi; Arantxa Mas; Vanesa Arauzo; José M Añón; Francisco Ruiz; José Ferreres; Roser Tomás; Marta Alabert; Ana Isabel Tizón; Susana Altaba; Noemi Llamas; Rafael Fernandez Journal: Intensive Care Med Date: 2017-09-22 Impact factor: 17.440
Authors: Mohammad Taghi Beigmohammadi; Zahid Hussain Khan; Shahram Samadi; Ata Mahmoodpoor; Akbar Fotouhi; Abbas Rahimiforoushani; Mehrnaz Asadi Gharabaghi Journal: Anesth Pain Med Date: 2016-01-16