Evaluation of a New Index of Mechanical Ventilation Weaning

Souza, Leonardo Cordeiro de; Guimarães, Fernando Silva; Lugon, Jocemir Ronaldo

doi:10.1177/0885066613483265

Cited by 21 publications

(62 citation statements)

References 35 publications

(124 reference statements)

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“… 1 , 2 Weaning indices are used in order to evaluate lung mechanics and can provide information regarding the causes of mechanical ventilation (MV) dependence. 3 , 4 It is currently recommended that weaning indices be used only in cases in which it is difficult to make a decision; the decision to perform a spontaneous breathing trial (SBT) should not be based on any one weaning index. 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

“…The rapid shallow breathing index (RSBI), which is also referred to as the ratio of respiratory rate to tidal volume (f/V T ), is the most widely used predictor of weaning success because it is easy to use and interpret. 1 , 4 , 7 - 13 The 2007 international consensus guidelines for weaning from MV, the 2007 Brazilian consensus guidelines for weaning from MV, and the 2013 Brazilian guidelines for MV underscore the clinical utility of the RSBI and recommend its use. 5 , 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

“…In such cases, the performance of the RSBI is far worse than that of other predictors, such as the Glasgow Coma Scale score and the recently described timed inspiratory effort (TIE) index. 4 , 12 , 13 , 18 , 19 …”

Section: Introductionmentioning

confidence: 99%

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The rapid shallow breathing index as a predictor of successful mechanical ventilation weaning: clinical utility when calculated from ventilator data

Souza

Lugon

2015

J. bras. pneumol.

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OBJECTIVE: The use of the rapid shallow breathing index (RSBI) is recommended in ICUs, where it is used as a predictor of mechanical ventilation (MV) weaning success. The aim of this study was to compare the performance of the RSBI calculated by the traditional method (described in 1991) with that of the RSBI calculated directly from MV parameters. METHODS: This was a prospective observational study involving patients who had been on MV for more than 24 h and were candidates for weaning. The RSBI was obtained by the same examiner using the two different methods (employing a spirometer and the parameters from the ventilator display) at random. In comparing the values obtained with the two methods, we used the Mann-Whitney test, Pearson's linear correlation test, and Bland-Altman plots. The performance of the methods was compared by evaluation of the areas under the ROC curves. RESULTS: Of the 109 selected patients (60 males; mean age, 62 ± 20 years), 65 were successfully weaned, and 36 died. There were statistically significant differences between the two methods for respiratory rate, tidal volume, and RSBI (p < 0.001 for all). However, when the two methods were compared, the concordance and the intra-observer variation coefficient were 0.94 (0.92-0.96) and 11.16%, respectively. The area under the ROC curve was similar for both methods (0.81 ± 0.04 vs. 0.82 ± 0.04; p = 0.935), which is relevant in the context of this study. CONCLUSIONS: The satisfactory performance of the RSBI as a predictor of weaning success, regardless of the method employed, demonstrates the utility of the method using the mechanical ventilator.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The rapid shallow breathing index as a predictor of successful mechanical ventilation weaning: clinical utility when calculated from ventilator data

Souza

Lugon

2015

J. bras. pneumol.

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“…3 According to the Sixth International Consensus Conference on Intensive Care Medicine, 10 patients who meet satisfactory weaning criteria should be considered ready for weaning. To improve the performance of the mechanical ventilator weaning, new indexes 11,12 have been proposed and applied to different populations. 13 The objective of this study is to evaluate the variables associated with successful weaning from mechanical ventilation in elderly subjects, observing traditional predictors and the integrative weaning index (IWI).…”

Section: Introductionmentioning

confidence: 99%

The Integrative Weaning Index in Elderly ICU Subjects

et al. 2016

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“…11 It is also critical to assess respiratory muscle force generation, a decisive factor in successful weaning, before a weaning trial because failed weaning is associated with pneumonia, prolonged hospital and ICU stays, and even increased mortality. 12 The aims of this study were to investigate whether the initial RBC AChE assay can help predict duration of mechanical ventilation and whether RBC AChE assay at weaning can predict outcomes of weaning organophosphatepoisoned patients from mechanical ventilation.…”

Section: Introductionmentioning

confidence: 99%

Utility of Red Blood Cell Acetylcholinesterase Measurement in Mechanically Ventilated Subjects After Organophosphate Poisoning

Moon

Chun

2014

Respir Care

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BACKGROUND: Many patients with organophosphate poisoning require mechanical ventilation. Muscle acetylcholinesterase (AChE) activity determines the impairment of muscle force generation, and red blood cell (RBC) AChE has been regarded as a surrogate for muscle AChE in organophosphate poisoning. Therefore, this study was conducted to investigate whether RBC AChE at presentation can predict the duration of mechanical ventilatory support and whether RBC AChE at weaning can predict weaning trial outcomes in patients on mechanical ventilation for organophosphate poisoning. METHODS: This retrospective observational case series identified 74 patients with a history of mechanical ventilation secondary to organophosphate poisoning and whose RBC AChE levels were available at presentation to the emergency department, at 24 h of presentation, or at weaning. Data were collected for plasma cholinesterase assay results, weaning outcome, duration of mechanical ventilation, and details of patient management (including ICU stay and amount of atropine and pralidoxime administered). RESULTS: RBC AChE activity levels at presentation and at 24 h of presentation had a negative correlation with duration of mechanical ventilation in subjects who ingested dimethyl organophosphate, but this correlation was not observed for those who had ingested diethyl or unclassified organophosphate. The optimal cutoff value of RBC AChE activity at presentation for predicting mechanical ventilation for < 7 d was 1,330 U/L in subjects intoxicated with dimethyl organophosphate. However, there was no difference in RBC AChE activity at the time of weaning trial between successful and failed weaning events, regardless of the chemical formulation of organophosphate. CONCLUSIONS: We conclude that RBC AChE activity within 24 h of presentation can help predict the duration of mechanical ventilation for dimethyl organophosphate intoxication; however, RBC AChE activity at the time of weaning trial may not be a suitable parameter for predicting a patient's ability to be weaned from mechanical ventilation.

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Evaluation of a New Index of Mechanical Ventilation Weaning

Abstract: The TIE index performed better than the best weaning indices used in clinical practice.

Cited by 21 publications

References 35 publications

The rapid shallow breathing index as a predictor of successful mechanical ventilation weaning: clinical utility when calculated from ventilator data

The rapid shallow breathing index as a predictor of successful mechanical ventilation weaning: clinical utility when calculated from ventilator data

The Integrative Weaning Index in Elderly ICU Subjects

Utility of Red Blood Cell Acetylcholinesterase Measurement in Mechanically Ventilated Subjects After Organophosphate Poisoning

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