Serial measurements of f/VT can predict extubation failure in patients with f/VT ≤ 105?

Teixeira, Cassiano; Teixeira, Paulo José Zimermann; Höher, Jorge Amilton; Leon, Patrícia Pickersgill de; Brodt, S; Moreira, José da Siva

doi:10.1016/j.jcrc.2007.12.011

Cited by 25 publications

(17 citation statements)

References 25 publications

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“…With regard to training load, we monitored the patients' heart rate and systolic and diastolic blood pressure throughout the study. In contrast to the results of a previous study, 13 we found a significant increase in heart rate only when systolic and diastolic blood pressure were not significantly different before and after training. A previous study also found that mobilization (ie, sitting on the edge of the bed, sitting to standing, a standing transfer from the edge of the bed to a chair or walking) significantly increased heart rate and blood pressure and caused a nonsignificant S pO 2 decrease in acutely ill patients.…”

Section: Discussioncontrasting

confidence: 99%

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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: 99%

“…13 A sample size of 16 patients was therefore required in each group to demonstrate a f/V T difference of 20 with a statistical power of 80% and a 2-sided ␣ level of Ͻ .05.…”

Section: Discussionmentioning

confidence: 99%

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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“…Tanios et al (24) demonstrated that including f/ V T in a protocol prolonged weaning time (2.0 vs. 3.0 days; p = 0.04); in addition, that weaning predictor neither conferred survival benefit nor reduced the incidence of extubation failure. (25) A multicenter randomized controlled trial with concealed allocation compared the usual care for weaning with computer-driven weaning, and the investigators found a reduction in weaning time (5 days vs. 3 days; p = 0.01) and in the total duration of MV (12.0 days vs. 7.5 days; p = 0.003); however, the reintubation rates did not differ (23% vs. 16%; p = 0.4). (26) Kollef et al (27) argued that protocol-guided weaning from MV is safe and leads to extubation more rapidly than does physician-directed weaning.…”

Section: Resultsmentioning

confidence: 99%

Impacto de um protocolo de desmame de ventilação mecânica na taxa de falha de extubação em pacientes de difícil desmame

et al. 2012

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Objective: To determine whether the predictive accuracy of clinical judgment alone can be improved by supplementing it with an objective weaning protocol as a decision support tool. Methods: This was a multicenter prospective cohort study carried out at three medical/surgical ICUs. The study involved all consecutive difficultto-wean ICU patients (failure in the first spontaneous breathing trial [SBT]), on mechanical ventilation (MV) for more than 48 h, admitted between January of 2002 and December of 2005. The patients in the protocol group (PG) were extubated after a T-piece weaning trial and were compared with patients who were otherwise extubated (non-protocol group, NPG). The primary outcome measure was reintubation within 48 h after extubation. Results: We included 731 patients-533 (72.9%) and 198 (27.1%) in the PG and NPG, respectively. The overall reintubation rate was 17.9%. The extubation success rates in the PG and NPG were 86.7% and 69.6%, respectively (p < 0.001). There were no significant differences between the groups in terms of age, gender, severity score, or pre-inclusion time on MV. However, COPD was more common in the NPG than in the PG (44.4% vs. 17.6%; p < 0.001), whereas sepsis and being a post-operative patient were more common in the PG (23.8% vs. 11.6% and 42.4% vs. 26.4%, respectively; p < 0.001 for both). The time on MV after the failure in the first SBT was higher in the PG than in the NPG (9 ± 5 days vs. 7 ± 2 days; p < 0.001). Conclusions: In this sample of difficult-to-wean patients, the use of a weaning protocol improved the decision-making process, decreasing the possibility of extubation failure.Keywords: Ventilator weaning; Ventilation; Ventilators, mechanical. ResumoObjetivo: Determinar se a acurácia preditiva do julgamento clínico isolado pode ser melhorada com o uso suplementar de um protocolo de desmame objetivo como ferramenta de suporte para a tomada de decisão. Métodos: Estudo prospectivo multicêntrico de coorte realizado em três UTIs clínicas/cirúrgicas. Foram incluídos no estudo todos os pacientes de desmame difícil (falha no primeiro teste de ventilação espontânea [TVE]), sob ventilação mecânica (VM) por mais de 48 h, admitidos em uma das UTIs entre janeiro de 2002 e dezembro de 2005. Os pacientes do grupo protocolo (GP) foram extubados após teste de tubo T de acordo com um protocolo de desmame e comparados com o grupo de pacientes extubados sem o uso do protocolo (GNP). O desfecho primário foi a taxa de reintubação em até 48 h após a extubação. Resultados: Foram incluídos 731 pacientes -533 (72,9%) no GP e 198 (27,1%) no GNP. A taxa global de reintubação foi de 17,9%. As taxas de sucesso da extubação no GP e no GNP foram 86,7% e 69,6%, respectivamente (p < 0,001). Não houve diferenças significativas entre os grupos quanto a idade, gênero, escore de gravidade e tempo de VM antes da inclusão. Entretanto, DPOC foi mais frequente no GNP que no GP (44,4% vs. 17,6%; p < 0,001), ao passo que pacientes sépticos e em pós-operatório foram mais comuns no GP (23,8% vs. 1...

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“…In this study 7 , several predictive indexes were evaluated, and the RSBI showed greater sensitivity and specificity in identifying the patients who progressed toward successful extubation. Later studies conducted to evaluate the predictive power of the RSBI to identify the outcome of weaning and extubation found differences that were primarily related to the population studied and the technique used for measurement [8][9][10] . Currently, in some institutions, the decision to submit the patient to an SBT or extubation is often influenced by or based solely on the value of RSBI, which is usually measured once a day 11 .…”

Section: Introductionmentioning

confidence: 99%

Low pressure support changes the rapid shallow breathing index (RSBI) in critically ill patients on mechanical ventilation

Gonçalves

Silva

Basile-Filho

et al. 2012

Rev. bras. fisioter.

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Serial measurements of f/VT can predict extubation failure in patients with f/VT ≤ 105?

Cited by 25 publications

References 25 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

Impacto de um protocolo de desmame de ventilação mecânica na taxa de falha de extubação em pacientes de difícil desmame

Low pressure support changes the rapid shallow breathing index (RSBI) in critically ill patients on mechanical ventilation

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