Document Detail


The prediction of extubation success of postoperative neurosurgical patients using frequency-tidal volume ratios.
MedLine Citation:
PMID:  18250977     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The process of discontinuing neurological patients from mechanical ventilation is still controversial. The aim of this study was to report the outcome from extubating patients undergoing elective craniotomy and correlate the result with the measured f/V (t) ratio. MATERIALS AND METHODS: In a cohort prospective study, all consecutive patients who required mechanical ventilation for up to 6 h after elective craniotomy were eligible for inclusion in this study. Patients passing daily screening criteria automatically received a spontaneous breathing trial (SBT). Immediately previous to the extubation, the expired minute volume (VE), breathing frequency (f), and tidal volume (V (t)) were measured and the breathing frequency-to-tidal volume ratio (f/V (t)) was calculated; consciousness level based on Glasgow Coma Scale (GCS) was evaluated at the same time. The extubation was considered a failure when patients needed reintubation within 48 h. RESULTS: Ninety-two patients were extubated and failure occurred in 16%. Despite 15 patients failed extubation just one of them presented the f/V (t) score over 105. The best cutoff value for f/V (t) observed was 62, but with low specificity (0.53) and negative predictive values (0.29). Area under the ROC curve for the f/V (t) was 0.69 +/- 0.07 (P = 0.02). Patients who failed the extubation process presented higher incidence of pneumonia (80%), higher need for tracheostomy (33%) and mortality rate of 40%. CONCLUSION: The f/V (t) ratio does not predict extubation failure in patients who have undergone elective craniotomy. Patients who fail extubation present higher incidence of pneumonia, tracheostomy and higher mortality rate.
Authors:
Milena C Vidotto; Luciana C M Sogame; Christiane C Calciolari; Oliver A Nascimento; José R Jardim
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Neurocritical care     Volume:  9     ISSN:  1541-6933     ISO Abbreviation:  Neurocrit Care     Publication Date:  2008  
Date Detail:
Created Date:  2008-08-21     Completed Date:  2008-10-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101156086     Medline TA:  Neurocrit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  83-9     Citation Subset:  IM    
Affiliation:
Respiratory Physiotherapy Especialization Course, Federal University of São Paulo (Unifesp), Sao Paulo, Brazil. milenavidotto@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cohort Studies
Consciousness
Consciousness Disorders
Craniotomy*
Female
Humans
Intensive Care / methods*
Intubation, Intratracheal
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
ROC Curve
Respiratory Mechanics*
Tidal Volume*
Ventilator Weaning / methods*

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


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