Rafael Fernandez1, Juan Maria Raurich2, Teresa Mut3, Jesus Blanco4, Antonio Santos5, Ana Villagra6. 1. Intensive Care Department, Hospital de Sabadell, Parc Tauli s/n, 08208, Sabadell, Barcelona, Spain. rfernandez@cspt.es. 2. Intensive Care Department, Hospital Son Dureta, Andrea Doria 55, 07014, Palma de Mallorca, Spain. 3. Intensive Care Department, Hospital General, Avenida Benicasim s/n, 12004, Castelló de la Plana, Spain. 4. Intensive Care Department, Hospital Río Hortega, Cardenal Torquemada s/n, 47010, Valladolid, Spain. 5. Intensive Care Department, Complexo Hospitalario Universitario, Rua Ramon Baltar s/n, 15706, Santiago de Compostela, Spain. 6. Intensive Care Department, Hospital de Sabadell, Parc Tauli s/n, 08208, Sabadell, Barcelona, Spain.
Abstract
OBJECTIVE: To evaluate the ability of the new, built-in occlusion pressure (P0.1) measurement to predict extubation failure. DESIGN AND SETTING: Prospective observational multicentre study in the ICU of five general hospitals. PATIENTS: Hundred thirty patients on mechanical ventilation longer than 48 h when considered ready for weaning. MEASUREMENTS AND RESULTS: Patients underwent a 30-min spontaneous breathing trial with simultaneous monitoring of occlusion pressure (P0.1) and breathing pattern (f/Vt). Sixteen patients (12%) failed the weaning trial and full ventilatory support was resumed, while 114 tolerated the trial and were extubated. Twenty-one (18%) required reintubation within 48 h. The area under the ROC curve for diagnosing extubation failure was 0.53 for f/Vt, 0.59 for P0.1 and 0.61 for P0.1*f/Vt (p=NS). Accordingly, P0.1*f/Vt more than 100 detected extubation failure with a sensitivity of 0.89, specificity of 0.35, positive predictive value of 0.21 and negative predictive value of 0.94. CONCLUSION: During a first trial of spontaneous breathing on pressure support ventilation (PSV), bedside P0.1 and P0.1*f/Vt are of little help, if any, for predicting extubation failure.
OBJECTIVE: To evaluate the ability of the new, built-in occlusion pressure (P0.1) measurement to predict extubation failure. DESIGN AND SETTING: Prospective observational multicentre study in the ICU of five general hospitals. PATIENTS: Hundred thirty patients on mechanical ventilation longer than 48 h when considered ready for weaning. MEASUREMENTS AND RESULTS:Patients underwent a 30-min spontaneous breathing trial with simultaneous monitoring of occlusion pressure (P0.1) and breathing pattern (f/Vt). Sixteen patients (12%) failed the weaning trial and full ventilatory support was resumed, while 114 tolerated the trial and were extubated. Twenty-one (18%) required reintubation within 48 h. The area under the ROC curve for diagnosing extubation failure was 0.53 for f/Vt, 0.59 for P0.1 and 0.61 for P0.1*f/Vt (p=NS). Accordingly, P0.1*f/Vt more than 100 detected extubation failure with a sensitivity of 0.89, specificity of 0.35, positive predictive value of 0.21 and negative predictive value of 0.94. CONCLUSION: During a first trial of spontaneous breathing on pressure support ventilation (PSV), bedside P0.1 and P0.1*f/Vt are of little help, if any, for predicting extubation failure.
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