Pattern of spontaneous breathing: potential marker for weaning outcome

El-Khatib, Mohamad; Jamaleddine, Ghassan; Soubra, R.; Muallem, Musa

doi:10.1007/s001340000758

Cited by 60 publications

(21 citation statements)

References 19 publications

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“…In 2001, El-Khatib et al . showed that during the SBT, 13 patients who failed extubation (defined as reintubation within 24 hours) had lower complexity than 39 patients who were successfully extubated [36]. In 2003 Shen et al .…”

Section: Discussionmentioning

confidence: 99%

Do heart and respiratory rate variability improve prediction of extubation outcomes in critically ill patients?

et al. 2014

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IntroductionProlonged ventilation and failed extubation are associated with increased harm and cost. The added value of heart and respiratory rate variability (HRV and RRV) during spontaneous breathing trials (SBTs) to predict extubation failure remains unknown.MethodsWe enrolled 721 patients in a multicenter (12 sites), prospective, observational study, evaluating clinical estimates of risk of extubation failure, physiologic measures recorded during SBTs, HRV and RRV recorded before and during the last SBT prior to extubation, and extubation outcomes. We excluded 287 patients because of protocol or technical violations, or poor data quality. Measures of variability (97 HRV, 82 RRV) were calculated from electrocardiogram and capnography waveforms followed by automated cleaning and variability analysis using Continuous Individualized Multiorgan Variability Analysis (CIMVA™) software. Repeated randomized subsampling with training, validation, and testing were used to derive and compare predictive models.ResultsOf 434 patients with high-quality data, 51 (12%) failed extubation. Two HRV and eight RRV measures showed statistically significant association with extubation failure (P <0.0041, 5% false discovery rate). An ensemble average of five univariate logistic regression models using RRV during SBT, yielding a probability of extubation failure (called WAVE score), demonstrated optimal predictive capacity. With repeated random subsampling and testing, the model showed mean receiver operating characteristic area under the curve (ROC AUC) of 0.69, higher than heart rate (0.51), rapid shallow breathing index (RBSI; 0.61) and respiratory rate (0.63). After deriving a WAVE model based on all data, training-set performance demonstrated that the model increased its predictive power when applied to patients conventionally considered high risk: a WAVE score >0.5 in patients with RSBI >105 and perceived high risk of failure yielded a fold increase in risk of extubation failure of 3.0 (95% confidence interval (CI) 1.2 to 5.2) and 3.5 (95% CI 1.9 to 5.4), respectively.ConclusionsAltered HRV and RRV (during the SBT prior to extubation) are significantly associated with extubation failure. A predictive model using RRV during the last SBT provided optimal accuracy of prediction in all patients, with improved accuracy when combined with clinical impression or RSBI. This model requires a validation cohort to evaluate accuracy and generalizability.Trial registrationClinicalTrials.gov NCT01237886. Registered 13 October 2010.

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Section: Discussionmentioning

confidence: 99%

Do heart and respiratory rate variability improve prediction of extubation outcomes in critically ill patients?

et al. 2014

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“…The different results from Engoren's and El-Khatib studies [72,75] were attributed to the prevailing conditions during respiratory variability analysis. According to Caminal and Brochard, different levels of pressure support may alter breath-to-breath variability in an inverse way [79,80], something that could have played a role in the two previous studies.…”

Section: Breathing Variability and Complexity Indices As Weaning Predmentioning

confidence: 88%

“…El-Khatib et al [75] studied 52 patients diagnosed mostly with lung diseases and under mechanical ventilation in two phases: 1. under synchronized intermittent mandatory ventilation (SIMV) with RR ≤ 4 breaths/min and with no PS for 60 minutes and 2. during a CPAP trial of 5 cm H2O with no PS ventilation for other 60 minutes. Thirty-nine patients (75%) were successfully extubated and the remaining 13 patients failed weaning trial.…”

Section: Breathing Variability and Complexity Indices As Weaning Predmentioning

confidence: 99%

“…According to the authors, the different results from the two previous studies may be due to different weaning protocols that were implemented and different patient characteristics. Their patients had a mean age of 68 years, no history of pulmonary disease and a short duration of ventilatory support (3 days) whereas patients in the El-Khatib study [75] had a mean age of 50 years with predominantly underlying lung diseases and a longer duration of mechanical ventilation (11 days). Finally, in the Engoren study [72] cardiac surgery patients were included and indices of cardiac function were not presented, especially when low cardiac output states are associated with a Cheyne-Stokes breathing pattern.…”

Section: Breathing Variability and Complexity Indices As Weaning Predmentioning

confidence: 99%

See 1 more Smart Citation

Fractal Physiology, Breath-to-Breath Variability and Respiratory Diseases: An Introduction to Complex Systems Theory Application in Pulmonary and Critical Care Medicine

Papaioannou¹,

Pneumatikos²

2013

Practical Applications in Biomedical Engineering

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“…Despite optimizing these components, extubation failure still occurs in 2 to 25% of cases in the intensive care unit (ICU) likely from a disparity between work of breathing (WOB) and capacity of respiratory muscles [1, 2]. A trial of spontaneous breathing (SBT) is typically performed prior to extubation as a predictor of success [1, 3]. If a patient breathes shallow and rapidly during the trial, the patient may not tolerate spontaneous breathing [1, 3].…”

Section: Introductionmentioning

confidence: 99%

Abnormal Breathing Patterns Predict Extubation Failure in Neurocritically Ill Patients

Punj

Nattanmai

George

et al. 2017

Case Reports in Critical Care

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In neurologically injured patients, predictors for extubation success are not well defined. Abnormal breathing patterns may result from the underlying neurological injury. We present three patients with abnormal breathing patterns highlighting failure of successful extubation as a result of these neurologically driven breathing patterns. Recognizing abnormal breathing patterns may be predictive of extubation failure and thus need to be considered as part of extubation readiness.

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Pattern of spontaneous breathing: potential marker for weaning outcome

Cited by 60 publications

References 19 publications

Do heart and respiratory rate variability improve prediction of extubation outcomes in critically ill patients?

Do heart and respiratory rate variability improve prediction of extubation outcomes in critically ill patients?

Fractal Physiology, Breath-to-Breath Variability and Respiratory Diseases: An Introduction to Complex Systems Theory Application in Pulmonary and Critical Care Medicine

Abnormal Breathing Patterns Predict Extubation Failure in Neurocritically Ill Patients

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