Predictive efficacy of weaning index on mechanical ventilation evacuation

Abstract

Background: The timely weaning of mechanical ventilation can shorten intensive care unit (ICU) stay times and reduce the complications related to mechanical ventilation. This study sought to investigate the predictive role of a weaning index (WI) on mechanical ventilation evacuation by measuring minute ventilation volume (MVV) across different ventilation modes.Methods: Patients suffering from respiratory failure for a variety of reasons were included in the study if they received mechanical ventilation for more than 48 hours in the ICU. The patients were randomly allocated to either the assist/control (A/C) group or the pressure support ventilation (PSV) group according to the ventilator mode. The factors associated with weaning success and failure were analyzed.Results: A total of 40 patients participated in this study. Of these, 25 weaning cases were successful and 15 were failures. There were 19 cases in the A/C group, yielding a success rate of 63%, and 21 cases in the PSV group, yielding a success rate of 62%. There were no significant differences between the two groups in terms of age, gender, ideal weight, Acute Physiology and Chronic Health Evaluation (APACHE) II score, ICU stay time and hospitalization time. There were significant differences in the mechanical ventilation duration between the two groups (P<0.05). When the WI was less than 50.44, the sensitivity and specificity of predicting weaning success were 72% and 98%. The area under the receiver operating characteristic (ROC) curve was 0.928±0.03. When the WI of the A/C group was less than 61.45, the sensitivity and specificity of predicting weaning success were 98% and 72%, respectively. The area under the ROC curve was 0.917±0.068.When the WI of the PSV group was less than 51.45, the sensitivity and specificity of predicting weaning success were 74.6% and 100%, respectively. The area under the ROC curve was 0.933±0.046.Conclusions: Compared with RSBI, WI shows a better value in predicting weaning, especially for mechanically ventilated patients in PSV mode, WI has greater value in predicting weaning.

Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines

“…In the largest multicenter study to date, by Frutos-Vivar et al [ 81 ], 121 (13.4%) of 900 patients who passed the SBT had extubation failure; they showed that a 1-unit increase in the RSBI increased the risk of extubation failure by 0.9%. However, the reference value of the RSBI has varied in different studies, and several studies have suggested values (57–80 breaths/min/L) much lower than the previously recommended value of 105 breaths/min/L [ 81 , 83 , 85 , 87 ]. In four studies evaluating the predictive power of the RSBI for extubation failure, the area under the receiver operating characteristic curve ranged from 0.63 to 0.92, indicating good to excellent predictive power [ 82 , 83 , 85 , 87 ].…”

“…However, the reference value of the RSBI has varied in different studies, and several studies have suggested values (57–80 breaths/min/L) much lower than the previously recommended value of 105 breaths/min/L [ 81 , 83 , 85 , 87 ]. In four studies evaluating the predictive power of the RSBI for extubation failure, the area under the receiver operating characteristic curve ranged from 0.63 to 0.92, indicating good to excellent predictive power [ 82 , 83 , 85 , 87 ]. Segal et al [ 84 ] compared the risk of extubation failure according to changes in the variation of RSBI values measured continuously for 2 hours and reported that an increase in the RSBI of 20% or more was associated with extubation risk.…”

“…However, the different measurement methods, measurement timings, settings at the time of measurement, and cut-off values used in the various studies make it difficult to present a standard protocol. Recent research has proposed a new measure to replace the RSBI, though it did not deny the clinical predictive value of the RSBI [ 87 ]. Another method attempted to improve the predictive ability of the RSBI without increasing the difficulty or complexity of the measurement.…”