Capnometric Recirculation Gas Tonometry and Weaning from Mechanical Ventilation

Maldonado, Abel; Bauer, Torsten T.; Ferrer, Miquel; Hernández, Carme; Arancibia, Francisco; Rodríguez-Roisín, Robert; Torres, Antônio

doi:10.1164/ajrccm.161.1.9904080

Cited by 28 publications

(16 citation statements)

References 30 publications

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“…10 f/V T is significantly higher in patients who failed weaning. [21][22][23] Although there was no significant difference in weaning rate between the 2 groups, chair-sitting training was associated with a significant f/V T increase in our patients. Chair-sitting training, therefore, had no benefit on our patients' respiratory muscle function and might induce an increase in mechanical load to breathe in mechanically ventilated ICU patients.…”

Section: Discussioncontrasting

confidence: 54%

Chair-Sitting Exercise Intervention Does Not Improve Respiratory Muscle Function in Mechanically Ventilated Intensive Care Unit Patients

Chang

Huang

et al. 2011

Respir Care

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BACKGROUND: Chair-sitting may allow for more readily activated scalene, sternocleidomastoid, and parasternal intercostal muscles, and may raise and enlarge the upper thoracic cage, thereby allowing the thoracic cage to be more easily compressed. OBJECTIVE: To evaluate the effect of chair-sitting during exercise training on respiratory muscle function in mechanically ventilated patients. METHODS: We randomized 16 patients to a control group and 18 patients to a chairsitting group. The patients in the chair-sitting group were transferred by 2 intensive care unit nurses from bed to armchair and rested for at least 30 min, based on the individual patient's tolerance. We measured heart rate, blood pressure, S pO 2 , and respiratory rate. In the treatment group, before transferring the patient from bed to armchair, and 30 min after the completion of chair-sitting we measured respiratory muscle function variables, including the ratio of respiratory rate (f) to tidal volume (V T ), S pO 2 , maximum inspiratory pressure (P Imax ) and maximum expiratory pressure (P Emax ). In the control patients we took those same measurements while the patient was in semirecumbent position, before and after treatments, for at least 6 days or until the patient was discharged from the intensive care unit or died. RESULTS: The 2 groups did not significantly differ in age, sex, or clinical outcomes. Respiratory rate, V T , f/V T , S pO 2 , P Imax , and P Emax were not significantly better in the chair-sitting group. The study period significantly improved respiratory rate, V T , P Imax , and P Emax (all P < .001), but not f/V T . CONCLUSIONS: Six days of chair-sitting exercise training did not significantly improve respiratory muscle function in mechanically ventilated patients.

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Section: Discussioncontrasting

confidence: 54%

Chair-Sitting Exercise Intervention Does Not Improve Respiratory Muscle Function in Mechanically Ventilated Intensive Care Unit Patients

Chang

Huang

et al. 2011

Respir Care

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“…Leitch et al (22) stated that 20.9% of their patients required noninvasive ventilatory assistance after extubation. Some investigators (47)(48)(49) consider such patients to represent extubation failure; the Task Force did not mention this consideration.…”

Section: Systematic Errormentioning

confidence: 99%

Meta-analysis under the spotlight: Focused on a meta-analysis of ventilator weaning*

Tobin

Jubran²

2008

Critical Care Medicine

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An increase in study size, as achieved through the pooling of data in a meta-analysis, is mistakenly thought to increase external validity. On the contrary, combining heterogeneous studies poses considerable risk of systematic error, which impairs internal validity and, thus, external validity. The strength of recommendations in clinical practice guidelines is based on a misperception of the relative importance of systematic vs. random error in science.

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“…Previous studies have reported that early indirect parameters of cardiac function, such as capnometric recirculation gas tonometry and gastric intramucosal pH, were altered in patients who presented with failure to wean from mechanical ventilation. These findings can be explained by the likelihood that the increased respiratory workload during spontaneous test breathing can induce an intestinal mucosa hypoperfusion because of the adrenergic response and effort required to increase the blood flow to the respiratory muscles (31-33). Similarly, the BNP levels during the spontaneous breathing test might help physicians identify earlier those patients with postoperative heart failure and support decisions to discontinue mechanical ventilation after cardiac surgery, potentially decreasing the risk of weaning failure (6,18,21).…”

Section: Discussionmentioning

confidence: 99%

High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery

Lara¹,

Hajjar²,

Almeida³

et al. 2013

Clinics

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OBJECTIVE:The failure to wean from mechanical ventilation is related to worse outcomes after cardiac surgery. The aim of this study was to evaluate whether the serum level of B-type natriuretic peptide is a predictor of weaning failure from mechanical ventilation after cardiac surgery.METHODS:We conducted a prospective, observational cohort study of 101 patients who underwent on-pump coronary artery bypass grafting. B-type natriuretic peptide was measured postoperatively after intensive care unit admission and at the end of a 60-min spontaneous breathing test. The demographic data, hemodynamic and respiratory parameters, fluid balance, need for vasopressor or inotropic support, and length of the intensive care unit and hospital stays were recorded. Weaning failure was considered as either the inability to sustain spontaneous breathing after 60 min or the need for reintubation within 48 h.RESULTS:Of the 101 patients studied, 12 patients failed the weaning trial. There were no differences between the groups in the baseline or intraoperative characteristics, including left ventricular function, EuroSCORE and lengths of the cardiac procedure and cardiopulmonary bypass. The B-type natriuretic peptide levels were significantly higher at intensive care unit admission and at the end of the breathing test in the patients with weaning failure compared with the patients who were successfully weaned. In a multivariate model, a high B-type natriuretic peptide level at the end of a spontaneous breathing trial was the only independent predictor of weaning failure from mechanical ventilation.CONCLUSIONS:A high B-type natriuretic peptide level is a predictive factor for the failure to wean from mechanical ventilation after cardiac surgery. These findings suggest that optimizing ventricular function should be a goal during the perioperative period.

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Capnometric Recirculation Gas Tonometry and Weaning from Mechanical Ventilation

Cited by 28 publications

References 30 publications

Chair-Sitting Exercise Intervention Does Not Improve Respiratory Muscle Function in Mechanically Ventilated Intensive Care Unit Patients

Chair-Sitting Exercise Intervention Does Not Improve Respiratory Muscle Function in Mechanically Ventilated Intensive Care Unit Patients

Meta-analysis under the spotlight: Focused on a meta-analysis of ventilator weaning*

High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery

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