Weaning predictors do not predict extubation failure in simple-to-wean patients

Savi, Augusto; Teixeira, Cassiano; Silva, Joyce Michele; Borges, Luis Guilherme; Pereira, Priscila Alves; Pinto, Kamile Borba; Gehm, Fernanda; Moreira, Fernanda Callefe; Wickert, Ricardo; Trevisan, Cristiane Brenner Eilert; Maccari, Juçara Gasparetto; Oliveira, Roselaine Pinheiro de; Vieira, Sílvia Regina Rios

doi:10.1016/j.jcrc.2011.07.079

Cited by 85 publications

(62 citation statements)

References 34 publications

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“…Historically, weaning predictors have shown greater accuracy in discriminating weaning outcome compared with extubation outcome. 1,4,6,8,[15][16][17][18] Although the IWI is promising, it possibly presents the same pattern. Second, we did not use a fixed F IO 2 .…”

Section: Discussionmentioning

confidence: 99%

“…1,[7][8][9][10][11][12][13] However, none of them have yet presented good results in discriminating the outcome of extubation, even those most used in clinical practices, such as vital capacity, tidal volume (V T ), maximal inspiratory pressure, tracheal airway-occlusion pressure 0.1 s after the start of inspiratory flow (P 0.1 ), and ratio of breathing frequency (f) to V T (f/V T ). 4,8,11,[14][15][16][17][18] Recently, a new index was created, the integrative weaning index (IWI). This index evaluates respiratory mechanics, oxygenation, and respiratory pattern in an integrated manner.…”

Section: Introductionmentioning

confidence: 99%

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The Modified Integrative Weaning Index as a Predictor of Extubation Failure

Boniatti

Andrade

et al. 2013

Respir Care

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INTRODUCTION:The extubation period is one of the most challenging aspects for intensive care teams. Timely recognition of the return to spontaneous ventilation is essential for reducing costs, morbidity, and mortality. Several weaning predictors were studied in an attempt to evaluate the outcome of removing ventilatory support. The purpose of this study was to analyze the predictive performance of the modified integrative weaning index (IWI) in the extubation process. METH-ODS: A prospective study was performed in an ICU in a public hospital in Porto Alegre, Brazil, with 59 adult medical-surgical beds. The final population of the study comprised 153 patients receiving mechanical ventilation for over 48 h who were extubated during the period from February to November 2011. Demographic data and clinical parameters were collected in addition to extubation predictors, including static compliance of the respiratory system, ratio of breathing frequency to tidal volume, tracheal airway-occlusion pressure 0.1 s after the start of inspiratory flow, and modified IWI. RESULTS: Extubation failure was observed in 23 of the subjects (15%). Subjects with greater positive fluid balance, lower hemoglobin levels, and lower levels of bicarbonate presented a higher rate of reintubation. The 3 modified IWI values (the first and 30th minute of the spontaneous breathing trial and the difference between them), as well as the other ventilatory parameters and extubation predictors, displayed poor extubation outcome discrimination accuracy. All indexes presented small areas under the receiver operating characteristic curve, and no accurate cutoff point was identified. CONCLUSIONS: We concluded that modified IWI, similar to other extubation predictors, does not accurately predict extubation failure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Modified Integrative Weaning Index as a Predictor of Extubation Failure

Boniatti

Andrade

et al. 2013

Respir Care

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“…A limitation of SBTs is that they do not assess airway patency, 45 which must be taken into consideration when determining which patients are at risk for extubation failure. Two maneuvers are often performed when determining the feasibility of extubation.…”

Section: Decision To Extubatementioning

confidence: 99%

Tracheal ExtubationDiscussion

Artime¹,

Hagberg²

2014

Respir Care

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Tracheal extubation in both the critical care and anesthesia setting is not only an important milestone for patient recovery, but also a procedure that carries a considerable risk of complication or failure. Mechanical ventilation is associated with significant complications that are time-dependent in nature, with a longer duration of intubation resulting in a higher incidence of complications, including ventilator-associated pneumonia, and increased mortality. Extubation failure and subsequent re-intubation are associated with an overall increase in the duration of mechanical ventilation, increased mortality, a greater need for tracheostomy, and higher medical costs. These risks demand that the process of extubation be managed by practitioners with a detailed understanding of the causes of extubation failure and the potential complications. A pre-established extubation plan with considerations made for the possible need for re-intubation is of the utmost importance.

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“…However, whereas a formal ventilator-induced diaphragmatic dysfunction diagnosis requires an invasive muscular biopsy, 4,5 the bedside tools to monitor diaphragmatic dysfunction are quite limited. Maximal inspiratory pressure 6 is easily obtainable in cooperative patients, but it has a low specificity and evaluates only the maximum force that the inspiratory muscles are able to generate 7 ; in contrast, the measurement of diaphragmatic twitch following magnetic stimulation of the phrenic nerve 8 is more cumbersome. Finally, novel data suggest a possible role of diaphragm ultrasound.…”

Section: Introductionmentioning

confidence: 99%

The Ratio of Inspiratory Pressure Over Electrical Activity of the Diaphragm Remains Stable During ICU Stay and Is Not Related to Clinical Outcome

et al. 2016

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BACKGROUND:We previously described an index, defined as the ratio between the inspiratory muscle pressure (P mus ) and the electrical activity of the diaphragm (EA di ) (P mus /EA di index). In the present work, we describe the trend of P mus /EA di index over time, investigating whether it could be an indicator of muscular efficiency associated with risk factors for diaphragmatic injury and/or clinical outcomes. METHODS: This work is a retrospective analysis of subjects with measurements of P mus /EA di index obtained, on different days, during assisted ventilation. Effects of P mus /EA di index absolute value on clinical outcomes were investigated dividing subjects into those with P mus /EA di index higher or lower than the median. Effects of P mus /EA di index trend over time were analyzed, distinguishing between subjects with P mus /EA di index increasing or decreasing. RESULTS: Mean P mus /EA di index was 1.04 ؎ 0.67, and the median (interquartile range) was 1.00 (0.59 -1.34), without a systematic trend over the days. Demographic, ventilator, or outcome data did not significantly differ between subjects with P mus /EA di index higher or lower than the median. Similarly, we did not find relevant differences in subjects with P mus /EA di index increasing or decreasing over time. CONCLUSIONS: The P mus /EA di index value remained constant in each subject over time, although the inter-individual variability was high. Neither the P mus /EA di index nor its trends appeared to be associated with ventilatory variables or clinical outcome.

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Weaning predictors do not predict extubation failure in simple-to-wean patients

Cited by 85 publications

References 34 publications

The Modified Integrative Weaning Index as a Predictor of Extubation Failure

The Modified Integrative Weaning Index as a Predictor of Extubation Failure

Tracheal ExtubationDiscussion

The Ratio of Inspiratory Pressure Over Electrical Activity of the Diaphragm Remains Stable During ICU Stay and Is Not Related to Clinical Outcome

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