Document Detail


Dynamic changes in respiratory frequency/tidal volume may predict failures of ventilatory liberation in patients on prolonged mechanical ventilation and normal preliberation respiratory frequency/tidal volume values.
MedLine Citation:
PMID:  22273318     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Rapid shallow breathing index (RSBI, respiratory frequency [f] divided by tidal volume [Vt]) has been used to prognosticate liberation from mechanical ventilation (LMV). We hypothesize that dynamic changes in RSBI predict failed LMV better than isolated RSBI measurements. We conducted a retrospective study of patients who were mechanically ventilated (MV) for longer than 72 hours. Failed LMV was defined as need for reinstitution of MV within 48 hours post-LMV. Ventilatory frequency (f) and Vt (liters) were serially recorded. The instantaneous RSBI (i-RSBI) was defined as f/Vt. Dynamic f/Vt ratio (d-RSBI) was defined as the ratio between two consecutive i-RSBI (f/Vt) measurements ([f(2)/Vt(2)]/[f(1)/Vt(1)]). RSBI Product (RSB-P) was defined as (i-RSBI × d-RSBI). Data from 32 patients were analyzed (Acute Physiology and Chronic Health Evaluation II 13.4, male 69%, mean age 57 years). Mean length of stay was 19.5 days (11.5 ventilator; 14.1 intensive care unit days). For LMV failures, mean time to reinstitution of invasive MV was 20.8 hours. All patients had pre-LMV i-RSBI less than 100. Failed LMVs had higher i-RSBI values (68.9, n = 18) than successful LMVs (44.2, n = 23, P < 0.01). Failures had higher d-RSBI (1.48) than successful LMVs (1.05, P < 0.04). The RSB-P was higher for failed LMVs (118) than for successful LMVs (48.8, P < 0.01) with failures having larger proportion of pre-LMV d-RSBI values greater than 1.5 (39.0 vs 10.7%, P < 0.03). Pre-LMV RSB-P may offer early prediction of failed LMV in patients on MV for longer than 72 hours despite normal pre-LMV i-RSBI. Divergence between RSB-P for successful and failed LMVs occurred earlier than i-RSBI divergence with a greater proportion of pre-LMV d-RSBI greater than 1.5 among failures.
Authors:
Raeanna C Adams; Oliver L Gunter; Jonathan R Wisler; Melissa L Whitmill; James Cipolla; David E Lindsey; Christy Stehly; Steven M Steinberg; Charles H Cook; Stanislaw P A Stawicki
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  78     ISSN:  1555-9823     ISO Abbreviation:  Am Surg     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-25     Completed Date:  2012-04-03     Revised Date:  2013-04-09    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  69-73     Citation Subset:  IM    
Affiliation:
Department of Surgery, Division of Trauma & Surgical Critical Care, Vanderbilt, University Medical Center, Nashville, Tennessee, USA.
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MeSH Terms
Descriptor/Qualifier:
APACHE
Chi-Square Distribution
Female
Humans
Length of Stay / statistics & numerical data
Male
Middle Aged
Pilot Projects
Predictive Value of Tests
Prognosis
Respiration, Artificial*
Respiratory Function Tests
Respiratory Rate / physiology*
Retrospective Studies
Tidal Volume / physiology*
Time Factors
Treatment Failure
Ventilator Weaning*
Comments/Corrections
Comment In:
Heart Lung. 2013 Mar;42(2):155   [PMID:  23273654 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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