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To determine whether subjecting patients to 100 ml of additional dead space after a 120-minute weaning trial could predict readiness for extubation.
This was a prospective, non-randomised pilot study in an intensive care unit at a university hospital with 14 beds. It included all non-tracheostomised patients with improvement of the underlying cause...
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Background:
The assessment of the work of breathing in the definitions of respiratory failure is vague and variable.
Objective:
Identify a parsimonious set of signs to describe the work of breathing in hypoxemic, acutely ill patients.
Methods:
We examined consecutive medical ICU patients receiving oxygen with a mask, non-invasive ventilation,...
Citations
... Post-extubation respiratory failure (PERF) is not a rare phenomenon and is associated with significant morbidity and mortality (2). Failure of extubation is defined as the requirement for reintubation or non-invasive mechanical ventilation within forty-eight hours of the initial extubation (3). Extubation failure (EF) happens in roughly 10-30% of all patients who meet the readiness requirements and have tolerated a spontaneous breathing trial (SBT) (4). ...
... Moreover, the results of the current study are similar to what was reported by [32] who studied the effectiveness of integrative weaning index (IWI) as a predictor of weaning success among 120 patients received mechanical ventilation for more than 24 hours and revealed that the use of the IWI shortens the total duration of mechanical ventilation and the ICU length of stay. The consistency across the previous studies can be justified by what [33] was suggested that the significant physiologic weaning parameters included in the IWI make it a better predictor than the other ones. ...
... (6,9) Although SBT has been proven to have high accuracy in predicting the weaning outcome, 12.4% to 21% of subjects who succeed in this test require reintubation within 48 to 72 hours. (6,7,(9)(10)(11)(12)(13)(14) One of the main reasons reported for reintubation is ineffective coughing, resulting in secretion retention in the postextubation period, which cannot be predicted by the SBT. (15)(16)(17) Many studies have reported that cough strength assessment by the measurement of cough peak flow is very accurate in predicting the extubation outcome. ...
Objective:
This systematic review was designed to assess the usefulness of cough peak flow to predict the extubation outcome in subjects who passed a spontaneous breathing trial.
Methods:
The search covered the scientific databases MEDLINE, Lilacs, Ibecs, Cinahl, SciELO, Cochrane, Scopus, Web of Science and gray literature. The Quality Assessment of Diagnostic Accuracy Studies was used to assess the methodological quality and risk of study bias. The statistical heterogeneity of the likelihood (LR) and diagnostic odds ratios were evaluated using forest plots and Cochran's Q statistic, and a crosshair summary Receiver Operating Characteristic plot using the multiple cutoffs model was calculated.
Results:
We initially retrieved 3,522 references from the databases; among these, 12 studies including 1,757 subjects were selected for the qualitative analysis. Many studies presented an unclear risk of bias in the "patient selection" and "flow and time" criteria. Among the 12 included studies, seven presented "high risk" and five "unclear risk" for the item "reference standard." The diagnostic performance of the cough peak flow for the extubation outcome was low to moderate when we considered the results from all included studies, with a +LR of 1.360 (95%CI 1.240 - 1.530), -LR of 0.218 (95%CI 0.159 - 0.293) and a diagnostic odds ratio of 6.450 (95%CI 4.490 - 9.090). A subgroup analysis including only the studies with a cutoff between 55 and 65 L/minute showed a slightly better, although still moderate, performance.
Conclusion:
A cough peak flow assessment considering a cutoff between 55 and 65L/minute may be useful as a complementary measurement prior to extubation. Additional well-designed studies are necessary to identify the best method and equipment to record the cough peak flow as well as the best cutoff.
... 2 In Portugal, data from 2011 shows that TB incidence among homeless was five times higher than within the general population. 3 This study intended to identify socio-demographic and health-related variables in the general population and among TB patients that are associated with TB incidence in the homeless population. ...
... Swallowing is usually assessed after airway decannulation, which needs patient transportation and complicated intervention, so Colonel et al. [14] used an easy bedside test for evaluation of swallowing function before extubation. Moreover, Solsona et al. [15] hypothesized that adding an additional burden (dead space volume of 100 cm 3 ) to the artificial airway after successful 2 h SBT may reduce extubation failure by predicting patients who will require reintubation. ...
... A cuffleak volume less than 110 ml carries a high risk of postextubation stridor and laryngeal edema [22]. (9) Performing the DSA test [15]: adding a tube with 100-ml internal volume between the endotracheal tube and T-piece to create a burden of increased dead space to patients supposed to be candidates for extubation. Patients were observed for any sign of distress [14]. ...
... Solsona et al. [15] hypothesized that by adding an extra burden i.e., DSA test, to that of spontaneous breathing can predict patients at risk of reintubation. Evaluation of swallowing before extubation was reported to be useful by Colonel et al. [14] in predicting extubation failure. ...
Introduction Extubation failure significantly increases duration of mechanical ventilation and ICU length of stay with increased risk of mortality. So validating certain parameters to predict extubation outcome and avoid extubation failure is necessary. This study aimed at assessing the usefulness of the dead space addition (DSA) test and swallowing evaluation in predicting extubation outcome in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD).
Patients and methods Invasively mechanically ventilated patients with COPD considered as candidates for extubation were enrolled and subjected to simplified acute physiology score II calculation, assessment of cough strength, endotracheal secretions quantity, delirium, cuff-leak test, DSA test, and swallowing before extubation.
Results A total of 90 patients with mean age of 62.26±7.01 years were enrolled. Overall, 76.9% of patients who failed the DSA test compared with 20.8% of those who accomplished it had failed extubation, and 57.1% of patients with defective swallowing compared with 10.9% of those with efficient swallowing had failed extubation, with a highly significant association between extubation outcome and both DSA fate and swallowing efficiency. Sensitivity, specificity, positive predictive value, and negative predictive value for DSA test were 38.5, 95.3, 76.9, and 79.2%, respectively, and for swallowing were 76.9, 76.6, 57.1, and 89.1%, respectively. An increase of simplified acute physiology score II by one unit increases extubation failure 1.25 times. Moreover, patients who tolerated DSA test whereas had defective swallowing had a likelihood of extubation failure 10 times.
Conclusion DSA can predict extubation success and failure by the same power, but swallowing assessment can predict extubation success more than failure. Combined DSA intolerance and defective swallowing increase the prediction of extubation failure by 31 times.
... The prevalence of reintubation within 48 -72 h after planned extubation is 9 -17% (average value of 13%). [4][5][6][7] In addition, re-intubation is associated with an 8-fold increase in nosocomial pneumonia and a 3-fold increase in hospital death. 8 Thus, it is very important to decrease re-intubation. ...
Background:
A ventilator includes the function to measure flow velocity. We aimed to compare the predictive accuracy for re-intubation diagnosed by cough peak flow (CPF) measured by a spirometer and a ventilator.
Methods:
Endotracheally intubated subjects who passed a spontaneous breathing trial were enrolled. Before extubation, CPF was measured by a spirometer and a ventilator, respectively. Re-intubation was recorded at 72 h after extubation.
Results:
A total of 126 subjects were enrolled. Among them, 15 subjects (12%) experienced re-intubation. CPF was lower in re-intubated subjects than those without re-intubation (measured by a spirometer: 54 ± 30 L/min vs 86 ± 37 L/min, P < .001; and measured by a ventilator: 50 ± 22 L/min vs 80 ± 26 L/min, P < .001). CPF measured by a spirometer and a ventilator had similar area under the curve of receiver operating characteristic (0.79 vs 0.83, P = .26). When a CPF of 56.4 L/min was measured by a spirometer as cutoff value, the sensitivity and specificity to distinguish re-intubation was 73 and 87%, respectively. When it was measured by a ventilator, the cutoff value, sensitivity, and specificity were 56 L/min, 73%, and 85%, respectively.
Conclusions:
CPF measurement by a ventilator was convenient, affordable, and safe. It had a predictive accuracy for re-intubation similar to that of a spirometer.
... Nevertheless, around 12-25% of the patients experience respiratory insufficiency postextubation and require re-intubation. [5] Hence, this method does not have accurate predictive value. ...
... The significant physiologic weaning parameters included in IWI may make it a better predictor than traditional ones. [4] ...
... Nevertheless, around 12-25% of the patients experience respiratory insufficiency postextubation and require re-intubation. [5] Hence, this method does not have accurate predictive value. ...
... The significant physiologic weaning parameters included in IWI may make it a better predictor than traditional ones. [4] ...
Objective:
To assess the effectiveness of integrative weaning index (IWI) as a predictor of weaning success.
Materials and Methods:
This is a prospective randomized controlled observer-blinded study and carried out on 120 patients of both sexes; patients who received mechanical ventilation for more than 24 h and met defined criteria for a weaning trial, underwent a 2-h spontaneous breathing trial with either IWI plus routine criteria of weaning (Group I n = 60) or routine criteria of weaning alone (control group) (Group C n = 60), in Group C the IWI was measured retrospective as it is not used in weaning decision. Those tolerated the trial would be immediately extubated. The primary outcome measure was the ability to maintain spontaneous, unassisted breathing for more than 48 h after extubation. Secondary outcome measures were the duration of mechanical ventilation, length of Intensive Care Unit (ICU) stay, and length of hospital stay.
Results:
The mean duration (hours) of mechanical ventilation and length of ICU stay (days) were significantly shorter in the Group I where the IWI was used (83.6 ± 34.3 vs. 97.49 ± 47.2 h, P = 0.002 and 5.5 ± 1.6 vs. 7.12 ± 2.3 days, P = 0.03, respectively). Weaning success rate was significantly higher in the Group I (53 vs. 34, P = 0.0001) while weaning failure rate was significantly lower in the Group I C (7 vs. 26, P = 0.0001).
Conclusion:
IWI is a strong predictor of both successful and failed weaning.
