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Eksombatchai D, Sukkratok C, Sutherasan Y, Junhasavasdikul D, Theerawit P. The ratio of respiratory rate to diaphragm thickening fraction for predicting extubation success. BMC Pulm Med 2023; 23:109. [PMID: 37016339 PMCID: PMC10071651 DOI: 10.1186/s12890-023-02392-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/17/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Several parameters are used to predict successful extubation but their accuracy varies among studies. We hypothesized that combining conventional and diaphragmatic parameters would be more effective than using just one. Our primary objective was to evaluate the performance of the respiratory rate in relation to the diaphragm thickening fraction (RR/DTF) ratio to predict the success of extubation. METHODS We enrolled 130 adult patients who required invasive mechanical ventilation, planned to be extubated, and used a spontaneous breathing trial (SBT) in the intensive care unit from July 2020 to April 2022. We measured the conventional parameters and the diaphragmatic parameters 2 h after SBT. The RR/DTF was calculated by dividing the respiratory rate (RR) by the diaphragm thickening fraction (DTF). The definition of weaning success is successful extubation within 48 h. RESULTS Of 130 patients, 8 patients (6.2%) were reintubated within 48 h. The RR/DTF was significantly lower in the successful extubation group than in the extubation failure group (right hemidiaphragm; 0.47 (0.33-0.64) vs 1.1 (0.6-2.32), p < 0.001 and left hemidiaphragm; 0.45 (0.31-0.65) vs 0.78 (0.48-1.75), p < 0.001). The right RR/DTF using a cut-off point at ≤ 0.81 had a sensitivity of 87.7%, a specificity of 75%, and areas under the receiver operating characteristic curve (AUROC) of 0.762 for predicting successful extubation (p = 0.013). The sensitivity, specificity, and AUROC for predicting extubation success of right DTF at a cut-off point of ≥ 26.2% were 84.3%, 62.5%, and 0.775, respectively (p = 0.009). CONCLUSION The RR/DTF ratio is a promising tool for predicting extubation outcome. Additionally, using RR/DTF was more reliable than conventional or diaphragmatic parameters alone in predicting extubation success.
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Affiliation(s)
- Dararat Eksombatchai
- Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Ramathibodi Hospital, Rama VI Road, Bangkok, 10400, Ratchathewi, Thailand
| | - Chalermwut Sukkratok
- Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Ramathibodi Hospital, Rama VI Road, Bangkok, 10400, Ratchathewi, Thailand
| | - Yuda Sutherasan
- Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Ramathibodi Hospital, Rama VI Road, Bangkok, 10400, Ratchathewi, Thailand
| | - Detajin Junhasavasdikul
- Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Ramathibodi Hospital, Rama VI Road, Bangkok, 10400, Ratchathewi, Thailand
| | - Pongdhep Theerawit
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Ramathibodi Hospital, Rama VI Road, Bangkok, 10400, Ratchathewi, Thailand.
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Vahedian-Azimi A, Gohari-Moghadam K, Rahimi-Bashar F, Samim A, Khoshfetrat M, Mohammadi SM, de Souza LC, Mahmoodpoor A. New integrated weaning indices from mechanical ventilation: A derivation-validation observational multicenter study. Front Med (Lausanne) 2022; 9:830974. [PMID: 35935785 PMCID: PMC9354807 DOI: 10.3389/fmed.2022.830974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background To develop ten new integrated weaning indices that can predict the weaning outcome better than the traditional indices. Methods This retrospective-prospective derivation-validation observational multicenter clinical trial (Clinical Trial.Gov, NCT 01779297), was conducted on 1,175 adult patients admitted at 9 academic affiliated intensive care units (ICUs; 4 surgical and 5 medical), from Jan 2013 to Dec 2018. All patients, intubated and mechanically ventilated for at least 24 h and ready for weaning were enrolled. The study had two phases: at first, the threshold values of each index that best discriminate between a successful and an unsuccessful weaning outcome was determined among 208 patients in the derivation group. In the second phase, the predictive performance of these values was prospectively tested in 967 patients in the validation group. In the prospective-validation set we used Bayes’ theorem to assess the probability of each test in predicting weaning. Results In the prospective validation group, sensitivity, specificity, diagnostic accuracy, positive and negative predictive values, and finally area under the receiver operator characteristic curves and standard errors for each index (ten formulae) were calculated. Statistical values of ten formulae for aforesaid variables were higher than 87% (0.87–0.99). Conclusion The new indices can be used for hospitalized patients in intensive care settings for accurate prediction of the weaning outcome.
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Affiliation(s)
- Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Keivan Gohari-Moghadam
- Medical ICU and Pulmonary Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshid Rahimi-Bashar
- Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Samim
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- *Correspondence: Abbas Samim,
| | - Masoum Khoshfetrat
- Department of Anesthesiology and Critical Care, Khatamolanbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Seyyede Momeneh Mohammadi
- Department of Anatomical Sciences, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Ata Mahmoodpoor
- Evidence Based Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Ata Mahmoodpoor,
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ZENGİN EN. Research trends and global productivity on mechanical ventilation with the impact of COVID-19: a bibliometric analysis in the period 1980-2021. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1122437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: Although the number of global studies on mechanical ventilation (MV) therapy, which plays an important role in the life process of patients in the intensive care unit, has increased, there is still no bibliometric research on this subject in the literature. This study, it was aimed to determine trend topics and global productivity by holistically analyzing scientific articles on MV published between 1980 and 2021 using various statistical methods and bibliometric approaches.
Material and Method: Articles on MV published between 1980 and 2021 were downloaded from the Web of Science (WoS) database and analyzed using various statistical methods. Spearman's correlation coefficient was used for correlation studies. Network visualization maps were used to identify the most effective studies with global collaborations, trend topics, and citation analysis.
Results: The study, which was in the category of 5323 articles out of a total of 10135 publications, was analyzed. The first 3 countries that contributed the most to the literature were the USA (n=1740), France (448), and Canada (386). The most active author was Laurent Brochard (n=50). The top 3 most active institutions were Assistance Publique Hopitaux Paris (224), University of Toronto (216), and League of European Research Universities (169). The top 3 journals that published the most articles were Critical Care Medicine (289), Chest (204), and Intensive Care Medicine (166). Gross Domestic Product (GDP) was highly effective in article productivity (r=0.719, p
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Yang TM, Chen L, Lin CM, Lin HL, Fang TP, Ge H, Cai H, Hong Y, Zhang Z. Identifying Novel Clusters of Patients With Prolonged Mechanical Ventilation Using Trajectories of Rapid Shallow Breathing Index. Front Med (Lausanne) 2022; 9:880896. [PMID: 35860741 PMCID: PMC9289367 DOI: 10.3389/fmed.2022.880896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivePatients with prolonged mechanical ventilation (PMV) are comprised of a heterogeneous population, creating great challenges for clinical management and study design. The study aimed to identify subclusters of PMV patients based on trajectories of rapid shallow breathing index (RSBI), and to develop a machine learning model to predict the cluster membership based on baseline variables.MethodsThis was a retrospective cohort study conducted in respiratory care center (RCC) at a tertiary academic medical center. The RCC referral criteria were patients with mechanical ventilation for at least 21 days with stable hemodynamic and oxygenation status. Patients admitted to the RCC from April 2009 to December 2020 were screened. Two-step clustering through linear regression modeling and k-means was employed to find clusters of the trajectories of RSBI. The number of clusters was chosen by statistical metrics and domain expertise. A gradient boosting machine (GBM) was trained, exploiting variables on RCC admission, to predict cluster membership.ResultsA total of 1371 subjects were included in the study. Four clusters were identified: cluster A showed persistently high RSBI; cluster B was characterized by a constant low RSBI over time; Cluster C was characterized by increasing RSBI; and cluster D showed a declining RSBI. Cluster A showed the highest mortality rate (72%), followed by cluster D (63%), C (62%) and B (61%; p = 0.005 for comparison between 4 clusters). GBM was able to predict cluster membership with an accuracy of > 0.95 in ten-fold cross validation. Highly ranked variables for the prediction of clusters included thyroid-stimulating hormone (TSH), cortisol, platelet, free thyroxine (T4) and serum magnesium.ConclusionsPatients with PMV are composed of a heterogeneous population that can be classified into four clusters by using trajectories of RSBI. These clusters can be easily predicted with baseline clinical variables.
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Affiliation(s)
- Tsung-Ming Yang
- Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Lin Chen
- Department of Critical Care Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
- Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University, Haikou, China
| | - Chieh-Mo Lin
- Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Hui-Ling Lin
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
- Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tien-Pei Fang
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
- Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Huiqing Ge
- Department of Respiratory Care, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huabo Cai
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yucai Hong
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhongheng Zhang
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Zhongheng Zhang
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Ghiani A, Paderewska J, Walcher S, Neurohr C. Mechanical power normalized to lung-thorax compliance predicts prolonged ventilation weaning failure: a prospective study. BMC Pulm Med 2021; 21:202. [PMID: 34140018 PMCID: PMC8210735 DOI: 10.1186/s12890-021-01566-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/21/2021] [Indexed: 01/18/2023] Open
Abstract
Background Mechanical power (MP) of artificial ventilation, the energy transferred to the respiratory system, is a chief determinant of adequate oxygenation and decarboxylation. Calculated MP, the product of applied airway pressure and minute ventilation, may serve as an estimate of respiratory muscle workload when switching to spontaneous breathing. The aim of the study was to assess MP’s discriminatory performance in predicting successful weaning from prolonged tracheostomy ventilation. Methods Prospective, observational study in 130 prolonged mechanically ventilated, tracheotomized patients in a specialized weaning center. Predictive weaning outcome ability of arterial blood gas analyses and indices derived from calculated MP at beginning and end of weaning was determined in terms of area under receiver operating characteristic curve (AUROC) and measures derived from k-fold cross-validation (likelihood ratios, diagnostic odds ratio, F1 score, and Matthews correlation coefficient [MCC]). Results Forty-four (33.8%) patients experienced weaning failure. Absolute MP showed poor discrimination in predicting outcome; whereas specific MP (MP normalized to dynamic lung-thorax compliance, LTCdyn-MP) had moderate diagnostic accuracy (MCC 0.38; AUROC 0.79, 95%CI [0.71‒0.86], p < 0.001), further improved by correction for corresponding mechanical ventilation PaCO2 (termed the power index of the respiratory system [PIrs]: MCC 0.52; AUROC 0.86 [0.79‒0.92], p < 0.001). Diagnostic performance of MP indices increased over the course of weaning, with maximum accuracy immediately before completion (LTCdyn-MP: MCC 0.49; AUROC 0.86 [0.78‒0.91], p < 0.001; PIrs: MCC 0.68; AUROC 0.92 [0.86‒0.96], p < 0.001). Conclusions MP normalized to dynamic lung-thorax compliance, a surrogate for applied power per unit of ventilated lung volume, accurately discriminated between low and high risk for weaning failure following prolonged mechanical ventilation. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01566-8.
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Affiliation(s)
- Alessandro Ghiani
- Department of Pulmonology and Respiratory Medicine, Schillerhoehe Lung Clinic (affiliated to the Robert-Bosch-Hospital GmbH, Stuttgart), Solitudestrasse 18, 70839, Gerlingen, Germany.
| | - Joanna Paderewska
- Department of Pulmonology and Respiratory Medicine, Schillerhoehe Lung Clinic (affiliated to the Robert-Bosch-Hospital GmbH, Stuttgart), Solitudestrasse 18, 70839, Gerlingen, Germany
| | - Swenja Walcher
- Department of Pulmonology and Respiratory Medicine, Schillerhoehe Lung Clinic (affiliated to the Robert-Bosch-Hospital GmbH, Stuttgart), Solitudestrasse 18, 70839, Gerlingen, Germany
| | - Claus Neurohr
- Department of Pulmonology and Respiratory Medicine, Schillerhoehe Lung Clinic (affiliated to the Robert-Bosch-Hospital GmbH, Stuttgart), Solitudestrasse 18, 70839, Gerlingen, Germany.,German Center for Lung Research (DZL), München, Germany
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Sepahyar M, Molavynejad S, Adineh M, Savaie M, Maraghi E. The Effect of Nursing Interventions Based on Burns Wean Assessment Program on Successful Weaning from Mechanical Ventilation: A Randomized Controlled Clinical Trial. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:34-41. [PMID: 33954096 PMCID: PMC8074739 DOI: 10.4103/ijnmr.ijnmr_45_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/11/2020] [Accepted: 09/26/2020] [Indexed: 11/04/2022]
Abstract
Background: The effective design and implementation of the nursing interventions to evaluate the patients' readiness for ventilator weaning will reduce their connection time to the ventilator and the complications of their connection to it. This study was conducted to examine the effect of nursing interventions based on the Burns Wean Assessment Program (BWAP) on successful weaning from Mechanical Ventilation (MV). Materials and Methods: In this clinical trial, 70 patients undergoing MV in the Intensive Care Units (ICUs) of Golestan Hospital (Ahvaz, Iran) in 2018 were randomly assigned to intervention and control groups. The nursing interventions designed based on BWAP were implemented on the patients in the intervention group, who were later weaned from the device according to this program. The recorded data included demographic information, BWAP score, vital signs, and laboratory values, which were analyzed using the Pearson correlation coefficient, Chi-Square, Fisher, and Mann-Whitney U tests. Results: There was a statistically significant and inverse correlation between the BWAP score and the MV duration such that a high BWAP score was associated with a shorter MV time (p = 0.041). Also, the mean number of re-intubation (p = 0.001) and the number of re-connection to the ventilator in the intervention group were significantly lower (p = 0.005). Conclusions: The results showed that nurses' assessment of patient's readiness for weaning from MV based on this tool and designed nursing care reduced the duration of MV, re-intubation, and re-connection.
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Affiliation(s)
- Maryam Sepahyar
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahram Molavynejad
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Adineh
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Savaie
- Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elham Maraghi
- Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Xue Y, Zhang Z, Sheng CQ, Li YM, Jia FY. The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children. BMC Pulm Med 2019; 19:270. [PMID: 31888586 PMCID: PMC6937936 DOI: 10.1186/s12890-019-1034-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction Multiple studies have shown that diaphragmatic ultrasound can better predict the outcome of weaning in adults. However, there are few studies focusing on children, leading to a lack of sufficient clinical evidence for the application of diaphragmatic ultrasound in children. The purpose of this study was to investigate the predictive value of diaphragm ultrasound for weaning outcomes in critically ill children. Methods The study included 50 cases whose mechanical ventilation (MV) time was > 48 h, and all eligibles were divided into either the weaning success group (n = 39) or the weaning failure group (n = 11). Diaphragm thickness, diaphragmatic excursion (DE), and diaphragmatic thickening fraction (DTF) were measured in the zone of apposition. The maximum inspiratory pressure (PImax) was also recorded. Results The ventilatory treatment time (P = 0.002) and length of PICU stay (P = 0.013) in the weaning failure group was longer than the success group. Cut-off values of diaphragmatic measures associated with successful weaning were ≥ 21% for DTF with a sensitivity of 0.82 and a specificity of 0.81, whereas it was ≥0.86 cm H2O/kg for PImax with a sensitivity of 0.51 and a specificity of 0.82. The linear correlation analysis showed that DTF had a significant positive correlation with PImax in children (P = 0.003). Conclusions Diaphragm ultrasound has potential value in predicting the weaning outcome of critically ill children. DTF and PImax presented better performance than other diaphragmatic parameters. However, DE has limited value in predicting weaning outcomes of children with MV. Trial registration Current Controlled Trials ChiCTR1800020196, (Dec 2018).
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Affiliation(s)
- Yang Xue
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, China
| | - Zhen Zhang
- Department of Pediatrics Intensive Care Unit, The First Hospital of Jilin University, Changchun, China
| | - Chu-Qiao Sheng
- Department of Pediatrics Intensive Care Unit, The First Hospital of Jilin University, Changchun, China
| | - Yu-Mei Li
- Department of Pediatrics Intensive Care Unit, The First Hospital of Jilin University, Changchun, China
| | - Fei-Yong Jia
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, China.
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Early Against Classic Extubation Outcomes Following Cardiac Surgery and Correlation With Rapid Shallow Breath Index. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.626844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sayed SS, Mohammed Hussein AA, Elddin Khaleel WG. Predictors of spontaneous breathing outcome in mechanically ventilated chronic obstructive pulmonary disease patients. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_81_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Huaringa AJ, Francis WH. Outcome of invasive mechanical ventilation in cancer patients: Intubate or not to intubate a patient with cancer. J Crit Care 2018; 50:87-91. [PMID: 30502688 DOI: 10.1016/j.jcrc.2018.11.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE The outcome of cancer patients who undergo mechanical ventilation has been grim. However, it has lately become more promising, creating hesitation when approaching the decision to intubate a cancer patient. Therefore, the main goal was to find some factors that could predict mortality. MATERIAL AND METHODS Studies were selected on the basis of their information wholeness, the year done, patients' number, participating country, underlying hematological or nonhematological malignancies, ventilation duration, ICU survival, hospital survival, long term survival, disease activity, and other contributing factors. RESULTS Twenty-two studies were included which accrued 3115 patients. The average ICU survival was 32.4%, and long-term survival was 10.2%. Over the years, the outcome of cancer patients undergoing mechanical ventilation has improved. The most important predicting factors are: The respiratory failure etiology, the performance status, the disease activity, and the SOFA score. CONCLUSIONS The aforementioned predicting factors could be used when approaching the decision to intubate. When in doubt, we should give the benefit to the patient, proceed to intubate and reevaluate progress daily and in doing so, we would suggest to use the trends in SOFA score and weaning index to assess success or failure of invasive mechanical ventilation.
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Affiliation(s)
- Armando J Huaringa
- Loma Linda University School of Medicine, White Memorial Medical Center, Los Angeles, California, Former Faculty, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States.
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González-Aguirre JE, Rivera-Uribe CP, Rendón-Ramírez EJ, Cañamar-Lomas R, Serna-Rodríguez JA, Mercado-Longoría R. Pulmonary Ultrasound and Diaphragmatic Shortening Fraction Combined Analysis for Extubation-Failure-Prediction in Critical Care Patients. Arch Bronconeumol 2018; 55:195-200. [PMID: 30446249 DOI: 10.1016/j.arbres.2018.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/06/2018] [Accepted: 09/30/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Invasive respiratory support is a cornerstone of Critical Care Medicine, however, protocols for withdrawal of mechanical ventilation are still far from perfect. Failure to extubation occurs in up to 20% of patients, despite a successful spontaneous breathing trial (SBT). METHODS We prospectively included ventilated patients admitted to medical and surgical intensive care unit in a university hospital in northern Mexico. At the end of a successful SBT, we measured diaphragmatic shortening fraction (DSF) by the formula: diaphragmatic thickness at the end of inspiration - diaphragmatic thickness at the end of expiration/diaphragmatic thickness at the end of expiration×100, and the presence of B-lines in five regions of the right and left lung. The primary objective was to determine whether analysis of DSF combined with pulmonary ultrasound improves prediction of extubation failure. RESULTS Eighty-two patients were included, 24 (29.2%) failed to extubation. At univariate analysis, DSF (Youden's J: >30% [sensibility and specificity 62 and 50%, respectively]) and number of B-lines regions (Youden's J: >1 zone [sensibility and specificity 66 and 92%, respectively]) were significant related to extubation failure (area under the curve 0.66 [0.52-0.80] and 0.81 [0.70-0.93], respectively). At the binomial logistic regression, only the number of B-lines regions remains significantly related to extubation failure (OR 5.91 [2.33-14.98], P<.001). CONCLUSION In patients with a successfully SBT, the absence of B-lines significantly decreases the probability of extubation failure. Diaphragmatic shortening fraction analysis does not add predictive power over the use of pulmonary ultrasound.
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Affiliation(s)
- Julio E González-Aguirre
- Department of Pulmonary and Critical Care Medicine, "Dr. José E. González" University Hospital, Nuevo León Autonomous University, Monterrey, Mexico.
| | - Claudia Paola Rivera-Uribe
- Department of Pulmonary and Critical Care Medicine, "Dr. José E. González" University Hospital, Nuevo León Autonomous University, Monterrey, Mexico
| | - Erick Joel Rendón-Ramírez
- Department of Pulmonary and Critical Care Medicine, "Dr. José E. González" University Hospital, Nuevo León Autonomous University, Monterrey, Mexico
| | | | | | - Roberto Mercado-Longoría
- Department of Pulmonary and Critical Care Medicine, "Dr. José E. González" University Hospital, Nuevo León Autonomous University, Monterrey, Mexico
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Baptistella AR, Sarmento FJ, da Silva KR, Baptistella SF, Taglietti M, Zuquello RÁ, Nunes Filho JR. Predictive factors of weaning from mechanical ventilation and extubation outcome: A systematic review. J Crit Care 2018; 48:56-62. [PMID: 30172034 DOI: 10.1016/j.jcrc.2018.08.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/06/2018] [Accepted: 08/18/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify, describe and discuss the parameters used to predict weaning from mechanical ventilation and extubation outcomes. METHODS Systematic review of scientific articles using four electronic databases: PubMed, Embase, PEDro and Cochrane Library. Search terms included "weaning", "extubation", "withdrawal" and "discontinuation", combined with "mechanical ventilation" and "predictive factors", "predictive parameters" and "predictors for success". In this study, we included original articles that presented predictive factors for weaning or extubation outcomes in adult patients and not restricted to a single disease. Articles not written in English were excluded. RESULTS A total of 43 articles were included, with a total of 7929 patients and 56 different parameters related to weaning and extubation outcomes. Rapid Shallow Breathing Index (RSBI) was the most common predictor, discussed in 15 studies (2159 patients), followed by Age and Maximum Inspiratory Pressure in seven studies. The other 53 parameters were found in less than six studies. CONCLUSION There are several parameters used to predict weaning and extubation outcomes. RSBI was the most frequently studied and seems to be an important measurement tool in deciding whether to wean/extubate a patient. Furthermore, the results demonstrated that weaning and extubation should be guided by several parameters, and not only to respiratory ones.
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Affiliation(s)
- Antuani Rafael Baptistella
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, SC, Brazil; Programa de Pós-Graduação em Biociências e Saúde/Universidade do Oeste de Santa Catarina, Brazil; Hospital Universitário Santa Terezinha, Joaçaba, SC, Brazil.
| | | | | | - Shaline Ferla Baptistella
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, SC, Brazil; Programa de Pós-Graduação em Biociências e Saúde/Universidade do Oeste de Santa Catarina, Brazil; Hospital Universitário Santa Terezinha, Joaçaba, SC, Brazil
| | | | | | - João Rogério Nunes Filho
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, SC, Brazil; Hospital Universitário Santa Terezinha, Joaçaba, SC, Brazil
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Zhao Z, Peng SY, Chang MY, Hsu YL, Frerichs I, Chang HT, Möller K. Spontaneous breathing trials after prolonged mechanical ventilation monitored by electrical impedance tomography: an observational study. Acta Anaesthesiol Scand 2017; 61:1166-1175. [PMID: 28832898 DOI: 10.1111/aas.12959] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The study objective was to examine the correlation between regional ventilation distribution measured with electrical impedance tomography (EIT) and weaning outcomes during spontaneous breathing trial (SBT). METHODS Fifteen patients received 100% automatic tube compensation (ATC) during the first and 70% during the second hour. Another 15 patients received external continuous positive airway pressure (CPAP) of 5 and 7.5 cmH2 O during the first and second hours, respectively. Regional ventilation distributions were monitored with EIT. RESULTS Tidal volume and tidal variation of impedance correlated significantly during assist-control ventilation and ATC in all patients (r2 = 0.80 ± 0.18, P < 0.001). Higher support levels resulted in similar ventilation distribution and tidal volume, but higher end-expiratory lung impedance (EELI) (P < 0.05). Analysis of regional intratidal gas distribution revealed a redistribution of ventilation towards dorsal regions with lower support level in 13 of 30 patients. These patients had a higher weaning success rate (only 1 of 13 patients failed). Eight of 17 other patient failed (P < 0.05). The number of SBT days needed for weaning was significantly lower in the former group of 13 patients (13.1 ± 4.0 vs. 20.9 ± 11.2 days, P < 0.05). CONCLUSIONS Regional ventilation distribution patterns during inspiration were associated with weaning outcomes, and they may be used to predict the success of extubation.
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Affiliation(s)
- Z. Zhao
- Institute of Technical Medicine; Furtwangen University; Villingen-Schwenningen Germany
- Department of Biomedical Engineering; Fourth Military Medical University; Xi'an China
| | - S.-Y. Peng
- Division of Pulmonary Medicine; Department of Internal Medicine; Far Eastern Memorial Hospital; New Taipei City Taiwan
| | - M.-Y. Chang
- Division of Pulmonary Medicine; Department of Internal Medicine; Far Eastern Memorial Hospital; New Taipei City Taiwan
| | - Y.-L. Hsu
- Division of Pulmonary Medicine; Department of Internal Medicine; Far Eastern Memorial Hospital; New Taipei City Taiwan
| | - I. Frerichs
- Department of Anesthesiology and Intensive Care Medicine; University Medical Center of Schleswig-Holstein Campus Kiel; Kiel Germany
| | - H.-T. Chang
- Medical Intensive Care Unit; Department of Critical Care Medicine; Far Eastern Memorial Hospital; New Taipei City Taiwan
| | - K. Möller
- Institute of Technical Medicine; Furtwangen University; Villingen-Schwenningen Germany
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