ObjectiveTo compare the predictive values of dynamic energy expenditure (EE) monitoring and the traditional method (rapid shallow breath index) for weaning in patient who is suitable for weaning from mechanical ventilation and accepts sequentially reduced support of ventilator.MethodsThis study included a total of 93 patients who were admitted to the Department of Intensive Care Medicine in 2018 to 2019, and were eligible for weaning from mechanical ventilation. The energy expenditure monitoring device of GE ventilator (CARESCAPE R860) was used to record the patient's change rate of EE [δEE(%), T1 (PSV 20/5), T2 (PSV 15/5), T3 (PSV 10-5/5), T4 (PSV 5/5)] while the ventilation support was declined. The differences in δEE were compared between the two groups of patients who were successful weaned (a successful group S) or failed (a failed group) at different phases. The receiver operator characteristic (ROC) curve was used to analyze the predictive value of δEE to the success rate of weaning.ResultA total of 36 patients failed weaning procedure. There was no significant difference in the basic status and disease type between the successful group and the failed group. There was no difference in δEE1 between T1-T2 phases [(5.67±2.31)% vs. (6.40±1.90)%, P>0.05], but significant difference in δEE between T2-T3 and T3-T4 phases [δEE2: (11.35±5.39)% vs. (14.21±6.33)%, P<0.05; δEE3: (8.39±3.90)% vs. (17.32±9.07)%, P<0.05]. The area under the ROC curve predicted by δEE2 and δEE3 for the patient's weaning results was higher than rapid shallow breath index (0.83 and 0.75 vs. 0.64, P<0.05).ConclusionDynamic energy expenditure monitoring can effectively evaluate and predict the success rate of weaning from mechanical ventilation, and can be applied to the clinical treatment process.
Objective To investigate whether the respiratory support weaning based on adaptive support ventilation ( ASV) could reduce the duration of mechanical ventilation in patients after fast-track coronary artery bypass grafting ( CABG) . Methods After CABG during the same fast-track general anesthesia, 46 patients were randomly assigned to an ASV group or a synchronized intermittent mandatory ventilation ( SIMV) group as control. The duration of mechanical ventilation, hemodynamic parameters, and airway pressures were recorded. Meanwhile, the variables and the number of the arterial blood gas were recorded. Results The duration of mechanical ventilation was shorter in the ASV group than that in the control group [ 196( 152-286) ] min vs. 253( 196-498) min, P lt;0. 05] . The duration of ICUstay was shorterin the ASV group than that in the control group [ ( 14. 5 ±0. 7) h vs. ( 16. 8 ±0. 4 ) h, P lt;0. 01] . Fewer arterial blood analyses were performed in the ASV group than those in the control group [ 5 ( 4-7) vs.7( 6-9) , P lt; 0. 05] . Conclusions A ventilation weaning protocol based on ASV is practicable. It may accelerate tracheal extubation, shorten the length of ICU stay, and simplify ventilation management in patients after fast-track CABG.
ObjectiveTo investigate the predictive value of diaphragm rapid shallow breathing index (D-RBSI) in weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD).MethodsSeventy-six patients with COPD who were undergoing mechanical ventilation were enrolled in department of critical care medicine of our hospital from March 2016 to March 2017. The patient underwent spontaneous breathing test (SBT) using CPAP mode after weaning screening. When the SBT had started 10 min or the SBT failed, the patients' respiratory rate (RR) and tidal volume were recorded, and the diaphragmatic displacement (DD) of patients was measured by bedside ultrasound. The ratio of RR to DD (RR/DD) was calculated as D-RBSI, and the predictive value of D-RBSI on weaning results in mechanically ventilated patients with COPD was analyzed by receiver operating characteristic (ROC) curve.ResultsTwenty-eight patients failed weaning procedure. There were no significant differences in age and acute physiology and chronic health evaluation II scores between the successful group and the failed group. The DD of the patients in the successful group was greater than that of the failed group [(22±6) mm vs. (13±5) mm, P<0.001]. RBSI and D-RBSI of the successful group were lower than those of the failure group [RBSI: (40±14) breaths/(min·L)vs. (52±20) breaths/(min·L), P=0.003; D-RBSI: (0.95±0.51) breaths/(min·mm) vs. (1.79±0.83) breaths/(min·mm), P<0.001)]. There was a good correlation between the RBSI and D-RBSI in the two groups (R2=0.778, P<0.001). The area under the ROC curve predicted the weaning result by D-RBSI was higher than RBSI (0.85vs. 0.75, P<0 001="" the="" cutoff="" value="" of="" d-rbsi="">1.13 breaths/(min·mm) to predict weaning failure had a sensitivity of 0.82, and a specificity of 0.81.ConclusionThe rapid shallow breathing index of diaphragm can be effectively used to predict the weaning result of COPD patients during mechanical ventilation.
ObjectiveTo investigate the value of noninvasive positive pressure ventilation in patients with high risk of weaning induced pulmonary oedema.MethodsFrom June 2018 to June 2019, 63 patients with mechanical ventilation in the Department of Critical Care Medicine of the First Hospital of Lanzhou University were enrolled. Randomized digital table method was randomly divided into two groups and the resulting random number assignment was hidden in opaque envelopes, the experimental group received non-invasive positive pressure ventilation (n=32), and the control group received mask oxygen therapy ventilation (n=31). The heart rate, respiratory rate, means arterial pressure, hypoxemia, reintubation, blood gas analysis and other indicators were compared between the two groups after 2 hours of weaning. The length of hospital stay, mortality and complications were compared between the two groups.ResultsAfter 2 hours of weaning, the heart rate and respiratory rate were significantly lower in the non-invasive positive pressure ventilation group than in the mask group (P<0.05). There was no difference in mean arterial pressure between the two groups of patients, which was not statistically significant (P>0.05). The incidence of hypoxemia, laryngeal edema and reintubation in the noninvasive positive pressure ventilation group was significantly lower than that in the mask group, which was statistically significant (P<0.05), and the blood gas analysis index was better than the mask group (P<0.05). The non-invasive positive pressure ventilation group was significantly shorter than the mask group in the length of hospital stay and intensive care unit (P<0.05). The hospital mortality rate in 28 days was lower than that in the mask group (P<0.05), but there was no difference in tracheotomy, pneumothorax and subcutaneous emphysema between the two groups (P>0.05).ConclusionsNoninvasive positive pressure ventilation can effectively prevent hypoxemia, laryngeal edema, and re-intubation in patients at high risk of withdrawal related pulmonary edema. It can also shorten the length of hospital stay, which is worth clinical attention and promotion.
ObjectiveTo evaluate the predictive value of diaphragmatic rapid shallow breathing index (D-RSBI) for weaning outcome prediction.MethodsThis was a prospective observation study. Respiratory rate (RR) and tidal volume (Vt) were recorded at the end of spontaneous breathing trial, and both M-Mode and B-Mode ultrasonography were used to assess the right diaphragmatic displacement (DD). In parallel, outcome of the weaning attempt, length of mechanical ventilation, length of stay in intensive care unit (ICU) and mortality of ICU were recorded. According to the weaning outcome, the patients were grouped into the successful group and the failed group. The receiver operator characteristic (ROC) curve was used to assess the value of rapid shallow breathing index (RSBI, RR/Vt) and D-RSBI (RR/DD) in predicting weaning failure for ICU patients with mechanical ventilation.ResultsA total of 110 patients recruited in this study. Of them, 73 (66.4%) patients were successfully liberated from mechanical ventilation, and 37 patients failed (33.6%) weaning procedure. The RSBI and D-RSBI of the patients in the failed group were higher than those in the success weaning group (P<0.01). The area under the ROC curves of RSBI and D-RSBI for predicting weaning failure was 0.78 (95% confidence interval 0.69 - 0.87), 0.91 (95% confidence interval 0.85 - 0.97), respectively, a cutoff of RSBI>69 breaths/(L·min) yielded sensitivity of 55% and specificity of 89%, and a cutoff of D-RSBI>1.5 breaths/(min·mm) yielded sensitivity of 87% and specificity of 80%.ConclusionD-RSBI is more accurate than traditional RSBI in predicting the weaning outcome.
ObjectiveTo investigate the clinical value of peripheral blood vitamin D level in predicting the outcome of weaning from mechanical ventilation in critically ill patients.MethodsA total of 130 critically ill patients who undergoing mechanical ventilation for more than 48 hours in our hospital were recruited from June 2014 to June 2017. Serum 25(OH)D3 was detected on admission and before spontaneous breathing test (SBT) meanwhile general clinical data and laboratory examination indexes were recorded. The cases were divided into a successful weaning group and a failure weaning group according to the outcome of weaning from mechanical ventilation. Logistic regression equation was used to analyze the relationship between vitamin D level and failure weaning, and a receiver operating characteristic (ROC) curve was used to analyze the predictive value for failure weaning.ResultsThere were 46 patients with failure weaning among 130 patients (35.38%). Compared with the successful weaning group, the failure weaning group had significantly higher Acute Physiology and Chronic Health EvaluationⅡ score, longer duration in intensive care unit, higher respiratory rate, higher rapid shallow breathing index, higher C-reactive protein, higher N-terminal prohormone of brain natriuretic peptide, higher serum creatinine, and significantly lower albumin (all P<0.05). 25(OH)D3 level classifications on admission and before SBT in the failure weaning group were worse than those in the successful weaning group (P<0.05). 25(OH)D3 levels of the failure weaning group were lower than those of the successful weaning group [on admission: (18.16±4.33) ng/ml vs. (21.60±5.25) ng/ml, P<0.05; before SBT: (13.50±3.52) ng/mlvs. (18.61±4.30) ng/ml, P<0.05]. Multivariate logistic regression analysis showed that 25(OH)D3 levels on admission and before SBT were independent risk factors for failure weaning (OR values were 2.257 and 2.613, respectively, both P<0.05). ROC curve analysis showed that areas under ROC curve were 0.772 and 0.836, respectively, with sensitivities of 80.3% and 85.2%, specificities of 69.0% and 71.0%, respectively.Conclusions25(OH)D3 deficiency or insufficiency is common in critically ill patients. The lower the level of vitamin D, the higher the risk of failure weaning. So it may be an independent predictor of failure weaning.
Objective To examine the adrenal function of critically ill patients received mechanical ventilation, and explore the relationship between the occurrence of relative adrenal insufficiency ( RAI) and weaning outcome.Methods Critically ill patients who were mechanically ventilated over 48 hours were enrolled in this study. Every patient was given one shot of corticotrophin 250 μg intravenously on the first day of admission and the first day of spontaneous-breathing-trial ( SBT) . Plasma contisol level was detected by radio-immunoassay before ( T0 ) and 30 minutes ( T30 ) after the shot. Meanwhile the following parameters were recorded including APACHEⅡ, age, and cause of disease, etc. RAI was defined as the difference between T0 and T30 ≤9 μg/dL. Receiver operating characteristic ( ROC) curve was used to evaluate the accuracy of the indicators towards the weaning outcome. Results A total of 45 patients with mechanical ventilation were recruited. The successful weaning group consisted 29 patients and the failure weaning group consisted 16 patients. The incidence of RAI in the successful weaning group ( 37.9% , 11/ 29) was significantly lower than that in the failure weaning group ( 75.0% , 12 /16) ( P=0. 017) . On the first day of admission, there was no significant difference of Δcortisol between the successful weaning group and the failure weaning group [ ( 10.3 ±5.7) μg/dL vs. ( 7.5 ±4.5) μg/dL, P=0.100) . On the first SBT day, Δcortisol of the successful weaning group was significantly higher than that in the failure weaning group [ ( 10.9 ±5.1) μg/dL vs. ( 4.9 ±2.9) μg/dL, P= 0.043] . Logistic regression analysis showed that Δcortisol was an independent risk factor of weaning. ROC curve analysis showed that on the first SBT day, the area under the curve of Δcortisol was 0.872; The sensitivity and the specificity of accurate judgmentwere 0.813 and 0.828 if Δcortisol ≤6. 95 μg/dL. Conclusions The occurrence of RAI is common in critically ill patients with mechanical ventilation. The adrenal function affects the outcome of weaning, and Δcortisol may be used as an important predictive indicator for weaning outcome.
Objective To analyze the prognostic factors in the postoperative patients with prolonged mechanical ventilation after extracorporeal circulation.Methods From Oct 2004 to Oct 2007，35 cases of postoperative patients after extracorporeal circulation required mechanical ventilation for ≥24 hours in ICU were enrolled.The patients were divided into death group and survival group.Preoperative variables including blood glucose，serum albumin，creatinine and ejection fraction（EF），intra-operative variables such as cardiopulmonary bypass（CPB） duration，aortic cross clamp（ACC） time，blood transfusion，and postoperative variables such as vital sign arrival at ICU，renal function，drainage in first 24 hours，APACHEⅡ score，ventilation duration were analyzed retrospectively.Results There were significant differences in blood glucose，serum albumin，EF，CPB，ACC，fresh frozen plasma transfusion，APACHEⅡ，creatinine，APTT and oxygenation index between the death group（12 cases，34.29%） and the survival group（23 cases，65.71%）.Stepwise logistic regression analysis indicated that EF（OR=0.7973，95%CI 0.6417-0.9906） and APACHEⅡ（OR=1.8588，95%CI 1.1071-3.1210） were predictors of prognosis.Conclusions High mortality is found in postoperative patients after extracorporeal circulation with prolonged mechanical ventilation.The main predictors of prognosis were EF and APACHEⅡ.It’s important to assess preoperative condition for cardiac surgical patients completely and provide more intensive perioperative care.
ObjectiveTo investigate whether inferior vena cava (IVC) ultrasound can improve the success rate of weaning in patients with respiratory failure by comparing the difference of success rate between ultrasound-guided weaning mode and spontaneous breathing test (SBT) weaning mode.MethodsFrom November 2017 to May 2018, 31 respiratory failure patients underwent mechanical ventilation in intensive care unit were randomly divided into an ultrasonic guidance group (16 cases) and a control group (15 cases). All of them were offline after meeting the offline indications. The routine group was assessed by SBT for offline procedures. The diameter and variation rate of inferior vena cava were measured at SBT. IVC diameter >2.0 cm and variation rate < 50% were given intravenous diuretics. After the IVC diameter reached the standard again, the catheter was taken off the machine after passing SBT. The patients of both groups were considered as successfully weaned when they were able to tolerate at least 48 consecutive hours of spontaneous breathing. The following data were recorded at weaning, ie. Acute Physiological and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, arterial blood gas analysis, plasma albumin, serum electrolyte sodium, potassium, 7-day and 14-day weaning success rate.ResultsThere were no significant differences in APACHEⅡ score, plasma albumin level, arterial oxygen partial pressure, carbon dioxide partial pressure, pH, blood sodium level or blood potassium level between the two groups at the beginning of weaning (all P>0.05), and the 2-day weaning success rate was higher in the ultrasound group than that in the control group (95% vs. 73%, P=0.039); the 7-day weaning success rate was higher in the ultrasound group than that in the control group (87% vs. 66%, P=0.043). No significant difference was found in the 14-day weaning success rate (68% in the ultrasound group vs. 53% in the control group, P=0.446).ConclusionUltrasound can improve the success rate of weaning in patients with respiratory failure.
Objective To compare the efficacy and safety of different airway humidification methods in patients with tracheotomy in weaning process. Methods Twelve patients with tracheotomy in the medical intensive care unit ( MICU) of the First Affiliated Hospital of Sue Yat-sen University fromSeptember 2008 to August 2009 were enrolled in which 45 case /times weaning tests in three different humidification ways were performed( 15 cases in each group) . Wet square gauze method was used in group A and traditional intermittent wet fluid drip method was used in group B. In group C, MR850 humidifier device, RT200 Venturi tube and T tube device were used to perform humidification. Comparisons were carried out between the three groups on sputum viscosity, comfort of patients before and after humidification, length of weaning time, frequencies of irritating coughs and phlegm formation during test period. Sputum viscosity was evaluated by airway secretion score ( AWSS) .Results There was no significant difference of sputum viscosity assessed by AWSS in group A before and after humidification( P gt; 0. 05 ) while AWSS was significantly increased in group B and group C ( P lt;0. 01) , implied that sputum viscosity was significantly lower than that of group A ( P lt;0. 05) . The scores of patients’comfortwere 3. 0 ±0. 4, 5. 0 ±1. 2, and 8. 0 ±1. 7 in groups A, B, and C respectively which mean that the patients in group C felt more comfortable than those in group A and group B ( P lt;0. 01) . Cough frequencies of groups A, B and C per hour were 0. 8,2. 6,and 0. 4 times/hour respectively in which the frequency of group B was significantly higher than those of group A and group C ( P lt;0. 01) . The frequency of phlegm formation in group A was 7 times in 15-times offline record, which was significantly higher than those in group B and group C ( P lt;0. 01) . Conclusions For the patients with tracheotomy in weaning process, MR850 humidifier device, RT200 Venturi tube and T tube device for humidification is superior in reducing sputum viscosity and phlegm formation, improving patient comfort, and reducing the occurrence of irritating cough.