Document Detail


Reduced breathing variability as a predictor of unsuccessful patient separation from mechanical ventilation.
MedLine Citation:
PMID:  16755257     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To compare descriptors of the breath-to-breath respiratory variability during a 60-min spontaneous breathing trial in patients successfully and unsuccessfully separated from the ventilator and the endotracheal tube and to assess the usefulness of these predictors in discriminating these two categories of patients. DESIGN: Prospective observational study. SETTING: Four general intensive care units in university hospitals. PATIENTS: A total of 51 consecutive patients mechanically ventilated for >24 hrs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Tidal volume, respiratory period, inspiratory time, expiratory time, mean inspiratory flow (tidal volume/inspiratory time), and duty cycle (inspiratory time/respiratory period) were obtained from the flow signal. Breath-by-breath variability was expressed in terms of their coefficients of variation (CV), the number of breaths among which a significant correlation was found (lag), and the autocorrelation coefficient between one breath and the following one. Five patients were excluded because of nonstationarity of the data, leaving 46 cases for analysis. Between-group comparison was conducted with the Mann-Whitney test, and a nonparametric classification and regression tree was used to identify variables discriminating "success" (n = 32) and "failure" patients (n = 14). All coefficients of variation were significantly higher in success patients, who also exhibited significantly less respiratory autocorrelation (shorter "short memory"). The classification and regression tree analysis allocated all success patients to a group defined by a coefficient of variation of tidal volume/inspiratory time of > or =19% and a coefficient of variation of inspiratory time/respiratory period of > or =10% that did not contain any failure patient. All failure patients belonged to a group with coefficient of variation of tidal volume/inspiratory time of <19%, a lag tidal volume of > or =11, and that contained no success patient. CONCLUSIONS: In intensive care unit patients undergoing a spontaneous breathing trial, breathing variability is greater in patients successfully separated from the ventilator and the endotracheal tube. Variability indices are sufficient to separate success from failure cases.
Authors:
Marc Wysocki; Christophe Cracco; Antonio Teixeira; Alain Mercat; Jean-Luc Diehl; Yannick Lefort; Jean-Philippe Derenne; Thomas Similowski
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  34     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-08-02     Completed Date:  2006-08-31     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2076-83     Citation Subset:  AIM; IM    
Affiliation:
UPRES EA 2397, Université Paris VI Pierre et Marie Curie, Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Acidosis, Respiratory / physiopathology
Adult
Aged
Female
Hospitals, University
Humans
Hypercapnia / physiopathology
Intensive Care Units
Intubation, Intratracheal*
Male
Middle Aged
Prospective Studies
Respiratory Function Tests
Severity of Illness Index
Ventilator Weaning*
Work of Breathing / physiology*
Comments/Corrections
Comment In:
Crit Care Med. 2006 Aug;34(8):2241-3   [PMID:  16883192 ]

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


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