Ángel Augusto Pérez-Calatayud1, Raúl Carrillo-Esper2, Emilio Arch-Tirado3. 1. Medicina Intensiva, Fundación Clínica Médica Sur, Grupo Mexicano Para el Estudio de la Medicina Intensiva, Ciudad de México, México. 2. Academia Nacional de Medicina, Academia Mexicana de Cirugía, Jefe de UTI Fundación Clínica Médica Sur, Fundador Grupo Mexicano Para el Estudio de la Medicina Intensiva, Ciudad de México, México. 3. Laboratorio de Neurobiología, Dirección de Investigación, Instituto Nacional de Rehabilitación, Ciudad de México, México.
Abstract
INTRODUCTION: Mechanical ventilation is a therapy for vital support used in a significant proportion of critically ill patients. The right time to successfully discontinue this therapy is a challenge for the intensive care specialist. For this reason it is still a subject for research. The echocardiographic evaluation of the diastolic dysfunction, the diaphragm, and the lung have become an invaluable tool for weaning from mechanical ventilation protocols, especially in patients with difficult or prolonged weaning from mechanical ventilation. There is still a need to validate, in controlled trials, the efficacy of an ultrasound protocol for weaning from mechanical ventilation that integrates the three modalities in a single protocol. METHODS: Based on current literature, we developed a score justified by a mathematical model based on inequations. When χ ⇒ 5 the risk of failure in the weaning process rises, the weaning process should be suspended; when χ ⇒ 1 the risk of failure is low, the weaning process should be continued. CONCLUSIONS: The use of math models for decision-making is of great importance, as it sets an objective parameter within the existing evaluations. We proposed the use of inequations to set intervals of solution with the three points of care for ultrasound-guided weaning from mechanical ventilation. With this, the inequations proposed generate an area of certainty within the proposed values and the solution intervals.
INTRODUCTION: Mechanical ventilation is a therapy for vital support used in a significant proportion of critically illpatients. The right time to successfully discontinue this therapy is a challenge for the intensive care specialist. For this reason it is still a subject for research. The echocardiographic evaluation of the diastolic dysfunction, the diaphragm, and the lung have become an invaluable tool for weaning from mechanical ventilation protocols, especially in patients with difficult or prolonged weaning from mechanical ventilation. There is still a need to validate, in controlled trials, the efficacy of an ultrasound protocol for weaning from mechanical ventilation that integrates the three modalities in a single protocol. METHODS: Based on current literature, we developed a score justified by a mathematical model based on inequations. When χ ⇒ 5 the risk of failure in the weaning process rises, the weaning process should be suspended; when χ ⇒ 1 the risk of failure is low, the weaning process should be continued. CONCLUSIONS: The use of math models for decision-making is of great importance, as it sets an objective parameter within the existing evaluations. We proposed the use of inequations to set intervals of solution with the three points of care for ultrasound-guided weaning from mechanical ventilation. With this, the inequations proposed generate an area of certainty within the proposed values and the solution intervals.