Can integrative weaning index be a routine predictor for weaning success?

Abstract

Objective:To assess the effectiveness of integrative weaning index (IWI) as a predictor of weaning success.Materials and Methods:This is a prospective randomized controlled observer-blinded study and carried out on 120 patients of both sexes; patients who received mechanical ventilation for more than 24 h and met defined criteria for a weaning trial, underwent a 2-h spontaneous breathing trial with either IWI plus routine criteria of weaning (Group I n = 60) or routine criteria of weaning alone (control group) (Group C n = 60), in Group C the IWI was measured retrospective as it is not used in weaning decision. Those tolerated the trial would be immediately extubated. The primary outcome measure was the ability to maintain spontaneous, unassisted breathing for more than 48 h after extubation. Secondary outcome measures were the duration of mechanical ventilation, length of Intensive Care Unit (ICU) stay, and length of hospital stay.Results:The mean duration (hours) of mechanical ventilation and length of ICU stay (days) were significantly shorter in the Group I where the IWI was used (83.6 ± 34.3 vs. 97.49 ± 47.2 h, P = 0.002 and 5.5 ± 1.6 vs. 7.12 ± 2.3 days, P = 0.03, respectively). Weaning success rate was significantly higher in the Group I (53 vs. 34, P = 0.0001) while weaning failure rate was significantly lower in the Group I C (7 vs. 26, P = 0.0001).Conclusion:IWI is a strong predictor of both successful and failed weaning.

Studying the power of the integrative weaning index in predicting the success rate of the spontaneous breathing trial in patients under mechanical ventilation

“…However, several studies have introduced this index as a desirable tool for predicting the weaning outcome reporting 90%–97% sensitivity, 66.7%–94% specificity, a PPV of 90%–99%, NPV of 50%–93%, and an accuracy of 87%–92%. [ 3 10 14 16 ] As the comparison of these data shows, except for the specificity reported by the current study which is lower than the lowest level reported in the previous studies, other studied parameters are in the same range as previous reports.…”

“…The reported range for the IWI positive and NLR in different studies is 2.84, 16.5, 0.03–0.12, respectively. [ 3 10 14 16 ] The only point which can justify the inconsistency in these findings is the difference in study design and the association between the likelihood ratio and the specificity parameter which was less in the current study in comparison to other studies. And last but not least is the IWI accuracy which was similar to the values reported by other studies.…”

“…[ 2 12 ] Especially when considering the RR-tidal volume ratio and the lungs static compliance, several studies have mentioned such indices as one of the main parameters associated with the weaning outcome. [ 10 13 14 15 ]…”

“…This study also revealed a fine agreement between the IWI and the parameters used by physicians in predicting the weaning outcome. As several studies have introduced IWI as an index with high sensitivity and specificity,[ 10 13 14 ] the small agreement between this index and other indices used by physicians can be attributed to the low sensitivity and specificity of the latter indices. Findings of the current study and Nemer et al .…”

The Integrative Weaning Index in Elderly ICU Subjects

“…17,23 On the other hand, the IWI, which can evaluate multiple essential functions, such as f/V T , compliance of the respiratory system, and oxygenation, presented higher predictive performance in a general population in the study of Nemer et al 11 and in the current study too. The IWI has been cited in several review studies, 11,[24][25][26][27] described as highly accurate, 11,25,26 and recommended by the Brazilian guidelines on mechanical ventilation. 24 Besides these advantages, the IWI can be measured regardless of the subject's cooperation.…”