| Do simple ventilation and gas exchange measurements predict early successful weaning from respiratory support in unselected general intensive care patients? | |
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MedLine Citation:
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PMID: 20656695 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The value of respiratory variables as weaning predictors in the intensive care unit (ICU) is controversial. We evaluated the ability of tidal volume (Vt(exp)), respiratory rate (f), minute volume (MV(exp)), rapid shallow breathing index (f/Vt), inspired-expired oxygen concentration difference [(I-E)O(2)], and end-tidal carbon dioxide concentration (Pe'(co(2))) at the end of a weaning trial to predict early weaning outcomes. METHODS: Seventy-three patients who required >24 h of mechanical ventilation were studied. A controlled pressure support weaning trial was undertaken until 5 cm H(2)O continuous positive airway pressure or predefined criteria were reached. The ability of data from the last 5 min of the trial to predict whether a predefined endpoint indicating discontinuation of ventilator support within the next 24 h was evaluated. RESULTS: Pre-test probability for achieving the outcome was 44% in the cohort (n=32). Non-achievers were older, had higher APACHE II and organ failure scores before the trial, and higher baseline arterial H(+) concentrations. The Vt, MV, f, and f/Vt had no predictive power using a range of cut-off values or from receiver operating characteristic (ROC) analysis. The [I-E]O(2) and Pe'(co(2)) had weak discriminatory power [area under the ROC curve: [I-E]O(2) 0.64 (P=0.03); Pe'(co(2)) 0.63 (P=0.05)]. Using best cut-off values for [I-E]O(2) of 5.6% and Pe'(co(2)) of 5.1 kPa, positive and negative likelihood ratios were 2 and 0.5, respectively, which only changed the pre- to post-test probability by about 20%. CONCLUSIONS: In unselected ICU patients, respiratory variables predict early weaning from mechanical ventilation poorly. |
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Authors:
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F Monaco; G B Drummond; P Ramsay; G Servillo; T S Walsh |
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Publication Detail:
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Type: Evaluation Studies; Journal Article Date: 2010-07-22 |
Journal Detail:
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Title: British journal of anaesthesia Volume: 105 ISSN: 1471-6771 ISO Abbreviation: Br J Anaesth Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-18 Completed Date: 2010-10-05 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0372541 Medline TA: Br J Anaesth Country: England |
Other Details:
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Languages: eng Pagination: 326-33 Citation Subset: IM |
Affiliation:
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Department of Cardiothoracic Anaesthesia and Intensive Care, Istituto Scientifico S. Raffaele, Via Olgettina 60, Milan 20132, Italy. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Female Humans Intensive Care* Male Middle Aged Positive-Pressure Respiration Predictive Value of Tests Prognosis Pulmonary Gas Exchange / physiology* Respiratory Function Tests / methods Respiratory Rate / physiology Tidal Volume / physiology Time Factors Ventilator Weaning* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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