1
|
Chung E, Leem AY, Lee SH, Kang YA, Kim YS, Chung KS. Predicting Successful Weaning through Sonographic Measurement of the Rapid Shallow Breathing Index. J Clin Med 2024; 13:4809. [PMID: 39200951 PMCID: PMC11355280 DOI: 10.3390/jcm13164809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/07/2024] [Accepted: 08/13/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Diaphragmatic dysfunction correlates with weaning failure, highlighting the need to independently assess the diaphragm's effects on weaning. We modified the rapid shallow breathing index (RSBI), a predictor of successful weaning, by incorporating temporal variables into existing ultrasound-derived diaphragm index to create a simpler index closer to tidal volume. Methods: We conducted a prospective observational study of patients who underwent a spontaneous breathing trial in the medical intensive care unit (ICU) at Severance Hospital between October 2022 and June 2023. Diaphragmatic displacement (DD) and diaphragm inspiratory time (Ti) were measured using lung ultrasonography. The modified RSBI was defined as follows: respiratory rate (RR) divided by DD was defined as D-RSBI, and RR divided by the sum of the products of DD and Ti on both sides was defined as DTi-RSBI. Results: Among the sonographic indices, DTi-RSBI had the highest area under the receiver operating characteristic (ROC) curve of 0.774 in ROC analysis, and a correlation was found between increased DTi-RSBI and unsuccessful extubation in a multivariable logistic regression analysis (adjusted odds ratio 0.02, 95% confidence interval 0.00-0.97). Conclusions: The DTi-RSBI is beneficial in predicting successful weaning in medical ICU patients.
Collapse
Affiliation(s)
- Eunki Chung
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea
- Department of Internal Medicine, Yonsei University Graduate School of Medicine, Seoul 03722, Republic of Korea
| | - Ah Young Leem
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Young Sam Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kyung Soo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| |
Collapse
|
2
|
Zheng Y, Luo Z, Cao Z. Mean platelet volume as a predictive biomarker for in-hospital mortality in patients receiving invasive mechanical ventilation. BMC Pulm Med 2022; 22:353. [PMID: 36115956 PMCID: PMC9482743 DOI: 10.1186/s12890-022-02155-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although mean platelet volume (MPV) has been reported to be associated with poor prognosis of various critical illness, the relationship between MPV and in-hospital mortality among patients undergoing invasive mechanical ventilation (IMV) is unclear.
Methods
A retrospective observational study including patients receiving IMV was conducted from January, 2014 to January, 2019. The patients were divided into two groups by MPV cutoff value. The receiver operating characteristics curve was used to evaluate the predictive ability of MPV for in-hospital mortality. Univariate and multivariate Cox regression analysis were conducted to analyze the value of MPV for predicting in-hospital mortality. Kaplan–Meier cumulative incidence curve was employed to observe the incidence of in-hospital mortality.
Results
A total of 274 patients were enrolled in the study, and 42 patients (15.3%) died in hospital. MPV > 11.4 fl was a valuable predictor for in-hospital mortality (AUC0.848; 95%CI, 0.800–0.889) with sensitivity 66.7%, and specificity = 86.21%. MPV > 11.4 fl was an independent risk factor for in-hospital mortality (adjusted HR 2.640, 95%CI, 1.208–5.767, P = 0.015). Compared to the group of MPV ≤ 11.4 fl, patients with MPV > 11.4 fl had increased mortality (log-rank test = 40.35, HR = 8.723, P < 0.0001). The relationship between MPV and in-hospital mortality was stronger in female patients than in male patients.
Conclusion
MPV > 11.4 fl is a more useful marker for predicting in-hospital mortality among critically ill patients receiving IMV, especially in female patients. Attention to the MPV marker is simple and profitable with immediate applicability in daily clinical practice.
Collapse
|
3
|
Zheng Y, Luo Z, Cao Z. Mean platelet volume is useful for predicting weaning failure: a retrospective, observational study. BMC Anesthesiol 2022; 22:160. [PMID: 35614411 PMCID: PMC9131520 DOI: 10.1186/s12871-022-01701-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background To evaluate the usefulness of mean platelet volume (MPV), a marker of inflammation and stress, for predicting weaning failure in patients undergoing invasive mechanical ventilation (IMV) compared to traditional inflammation markers. Methods The retrospective observational study including patients who received IMV and underwent spontaneous breathing trial (SBT) was conducted in ICU at Beijing Chao-Yang hospital in China from January, 2013 to December, 2019. According to the weaning outcome, MPV, leukocyte count and C-reaction protein(CRP) were compared between weaning failure and weaning success group. Receiver-operating characteristics (ROC) curves and multivariate logistical regression analysis were constructed to analyze the value of these inflammatory markers for predicting weaning failure. Results A total of 261 patients were enrolled in the study and 54 patients (20.7%) experienced weaning failure (45 SBT failure and 9 extubation failure after successful SBT). MPV was a better predictor for weaning failure (AUC 0.777;95%CI, 0.722–0.826) than leukocyte count (AUC 0.6;95%CI,0.538–0.66) and CRP (0.627;95%CI,0.565–0.685). The cutoff value of MPV for predicting weaning failure was 11.3 fl with sensitivity 55.56%, specificity 87.92%, and diagnostic accuracy 81.22%. According to multivariate logistic regression analyses, MPV > 11.3 fl was an independent risk factor for predicting weaning failure. Conclusions MPV could be a more valuable marker for predicting weaning failure. and the patients with MPV > 11.3 fl should be attentively evaluated before weaning since they are at high risk of weaning failure, and it would be auspicable for those patients to undergo a noninvasive ventilation or high-flow nasal cannula oxygen therapy after extubation or even an early tracheostomy.
Collapse
Affiliation(s)
- Yingying Zheng
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
| | - Zujin Luo
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhixin Cao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
4
|
Kyriakoudi A, Rovina N, Koltsida O, Kostakou E, Konstantelou E, Kardara M, Kompoti M, Palamidas A, Kaltsakas G, Koutsoukou A. Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation. Diagnostics (Basel) 2021; 12:diagnostics12010092. [PMID: 35054259 PMCID: PMC8774440 DOI: 10.3390/diagnostics12010092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/16/2021] [Accepted: 12/25/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Septic patients undergoing mechanical ventilation (MV) often experience difficulty in weaning. Th aim of this study was to determine whether inflammatory biomarkers of sepsis could be indicative of the failure or success of spontaneous breathing trial (SBT) in these patients. Methods: Sixty-five patients on MV (42 septic and 23 intubated for other reasons) fulfilling the criteria for SBT were included in the study. Blood samples were collected right before, at the end of (30 min) and 24 h after the SBT. Serum inflammatory mediators associated with sepsis (IL-18, IL-18BP, TNF) were determined and correlated with the outcome of SBT. Results: A successful SBT was achieved in 45 patients (69.2%). Septic patients had a higher percentage of SBT failure as compared to non-septic patients (85% vs. 15%, p = 0.026), with an odds ratio for failing 4.5 times (OR = 4.5 95%CI: 1.16–17.68, p 0.022). IL-18 levels and the relative mRNA expression in serum were significantly higher in septic as compared to non-septic patients (p < 0.05). Sepsis was independently associated with higher serum IL-18 and TNF levels in two time-point GEE models (53–723, p = 0.023 and 0.3–64, p = 0.048, respectively). IL-18BP displayed independent negative association with rapid shallow breathing index (RSBI) (95% CI: −17.6 to −4, p = 0.002). Conclusion: Sustained increased levels of IL-18 and IL-18BP, acknowledged markers of sepsis, were found to be indicative of SBT failure in patients recovering from sepsis. Our results show that, although subclinical, remaining septic inflammation that sustaines for a long time complicates the weaning procedure. Biomarkers for the estimation of the septic burden and the right time for weaning are needed.
Collapse
Affiliation(s)
- Anna Kyriakoudi
- 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and “Sotiria” Chest Disease Hospital, 11527 Athens, Greece; (A.K.); (O.K.); (E.K.); (E.K.); (A.P.); (G.K.); (A.K.)
| | - Nikoletta Rovina
- 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and “Sotiria” Chest Disease Hospital, 11527 Athens, Greece; (A.K.); (O.K.); (E.K.); (E.K.); (A.P.); (G.K.); (A.K.)
- Correspondence: ; Tel.: +30-210-7763650
| | - Ourania Koltsida
- 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and “Sotiria” Chest Disease Hospital, 11527 Athens, Greece; (A.K.); (O.K.); (E.K.); (E.K.); (A.P.); (G.K.); (A.K.)
| | - Eirini Kostakou
- 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and “Sotiria” Chest Disease Hospital, 11527 Athens, Greece; (A.K.); (O.K.); (E.K.); (E.K.); (A.P.); (G.K.); (A.K.)
| | - Elissavet Konstantelou
- 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and “Sotiria” Chest Disease Hospital, 11527 Athens, Greece; (A.K.); (O.K.); (E.K.); (E.K.); (A.P.); (G.K.); (A.K.)
| | - Matina Kardara
- 1st Department of Critical Care Medicine & Pulmonary Services, National and Kapodistrian University of Athens, Medical School, Evangelismos Hospital, 10676 Athens, Greece;
| | - Maria Kompoti
- Intensive Care Unit, General Hospital of Eleusis Thriasio, 13674 Athens, Greece;
| | - Anastasios Palamidas
- 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and “Sotiria” Chest Disease Hospital, 11527 Athens, Greece; (A.K.); (O.K.); (E.K.); (E.K.); (A.P.); (G.K.); (A.K.)
| | - Georgios Kaltsakas
- 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and “Sotiria” Chest Disease Hospital, 11527 Athens, Greece; (A.K.); (O.K.); (E.K.); (E.K.); (A.P.); (G.K.); (A.K.)
| | - Antonia Koutsoukou
- 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and “Sotiria” Chest Disease Hospital, 11527 Athens, Greece; (A.K.); (O.K.); (E.K.); (E.K.); (A.P.); (G.K.); (A.K.)
| |
Collapse
|
5
|
Cuerpo S, Moisés J, Hernández-González F, Benegas M, Ramirez J, Sánchez M, Agustí À, Sellares J. Acute exacerbations of idiopathic pulmonary fibrosis: Does clinical stratification or steroid treatment matter? Chron Respir Dis 2020; 16:1479973119869334. [PMID: 31431063 PMCID: PMC6704413 DOI: 10.1177/1479973119869334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is defined as a sudden acceleration of the disease with the appearance of pulmonary infiltrates superimposed on the characteristic pattern of IPF that leads to a significant decline in lung function. It has high in-hospital mortality rates, despite medical treatment with systematic steroids. We sought to investigate whether there were in-hospital mortality differences according to clinical stratification (AE, suspected AE, or AE of known cause) and/or treatment with systemic steroids. We reviewed the clinical characteristics and outcomes of patients with IPF admitted to our hospital during the years 2003-2014 due to a worsening of their clinical status. We identified 50 IPF patients, 9 with AE (18%), 12 with suspected exacerbation (24%), and 29 with AE of known cause (58%), mostly respiratory infections. In-hospital mortality was similar in the three groups (33% vs. 17% vs. 34%, respectively). Likewise, we did not find differences between them with respect to the use of systemic steroids (length of treatment duration or total dose). Nevertheless, there was an independent association between in-hospital mortality and high average daily steroid dose. We did not observe significant differences in prognosis or use of systemic steroids according to current diagnostic stratification groups in patients hospitalized because of an exacerbation of IPF.
Collapse
Affiliation(s)
- Sandra Cuerpo
- 1 Servei de Pneumologia, Respiratory Institute, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Jorge Moisés
- 1 Servei de Pneumologia, Respiratory Institute, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Fernanda Hernández-González
- 1 Servei de Pneumologia, Respiratory Institute, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Mariana Benegas
- 2 Servicio de Radiodiagnóstico, Hospital Clínic, Barcelona, Spain
| | - Jose Ramirez
- 3 Servicio de Anatomía Patológica, Hospital Clínic, Barcelona, Spain
| | - Marcelo Sánchez
- 2 Servicio de Radiodiagnóstico, Hospital Clínic, Barcelona, Spain
| | - Àlvar Agustí
- 1 Servei de Pneumologia, Respiratory Institute, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,4 Centro de Investigación Biomedica en Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain
| | - Jacobo Sellares
- 1 Servei de Pneumologia, Respiratory Institute, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,4 Centro de Investigación Biomedica en Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain
| |
Collapse
|
6
|
Chen YY, Jerng JS, Chen JJ, Chang FC, Kuo YW, Wang HC, Wu HD. Changes in albuminuria during the spontaneous breathing trial: A prospective observational study. J Formos Med Assoc 2020; 119:488-495. [PMID: 31324438 DOI: 10.1016/j.jfma.2019.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 06/11/2019] [Accepted: 07/04/2019] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND We hypothesized urine albumin concentration may detect the early increasing cardiac load during the spontaneous breathing trial (SBT). The purpose of our study is to determine whether the changes in urine albumin concentration before and after the SBT correlate with SBT outcome. METHODS This prospective observational study was conducted from January 2013 to September 2013. Patients receiving endotracheal tube intubation due to acute respiratory failure were included. Urine albumin concentration was measured upon admission to the intensive care unit, before and after the SBT. RESULTS A total of 211 patients with respiratory failure were screened. Finally, 69 patients were included for analysis. Among the 69 patients received the SBT, 61 patients passed the SBT while 8 patients didn't. Urine albumin concentration upon admission was 251.00 ± 108.21 mg/g in the SBT success group and 260.87 ± 77.95 mg/g in the SBT failure group (p = 0.97). The mean percent change in urine albumin concentration during the SBT was significantly higher in the SBT failure group (+58.44%) than in the SBT success group (+13.11%) (p = 0.02). Univariable and multivariable logistic regression model showed that the difference of urine albumin concentration before and after the SBT correlated significantly with SBT failure (adjusted OR:1.04, p = 0.01). CONCLUSION This open label pilot study demonstrates the significant association of the changes in urine albumin concentration with SBT outcome. Further study is warranted to investigate the predictive value of urine albumin concentration.
Collapse
Affiliation(s)
- You-Yi Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliou, Taiwan
| | - Jih-Shuin Jerng
- Division of Pulmonary Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jien-Jiun Chen
- Cardiovascular Center, National Taiwan University Hospital, Yun-Lin Branch, Douliou, Taiwan
| | - Fan-Chi Chang
- Division of Pulmonary Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Wen Kuo
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
| | - Hao-Chien Wang
- Division of Pulmonary Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Dong Wu
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
7
|
Baudel JL, Dubee V, Boelle PY, Bourcier S, Leblanc G, Joffre J, Bigé N, Preda G, Dumas G, Guidet B, Maury E, Ait-Oufella H. The Weaning Index combining EtCO2 and respiratory rate early identifies Spontaneous Breathing Trial failure. Minerva Anestesiol 2018; 85:384-392. [PMID: 30482002 DOI: 10.23736/s0375-9393.18.13108-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to evaluate the predictive value of the end-tidal CO2 (EtCO2) alone or combined with ventilation related parameters on Spontaneous Breathing Trial (SBT) outcome on mechanically ventilated patients. METHODS Prospective observational study in a medical Intensive Care Unit. Mechanically ventilated adult patients who met predefined criteria for weaning were included. Patients underwent a T-piece SBT for 30 minutes and the hemodynamic and respiratory clinical parameters including EtCO2 were recorded every five minutes. RESULTS The study included 280 patients, who were studied (age: 64±17 years, SAPS II: 44 [34-56]) during a first SBT and 76 patients during a second SBT. The Weaning Index, defined as the product of the respiratory rate and EtCO2, was a strong early predictive factor of SBT outcome; at 10 minutes, the area under the curve (AUC) was 86% ([80-90], P<0.0001) during the first SBT and 88% ([80-96], P<0.0001) during the second SBT. After 10 minutes of SBT, a Weaning Index >1100 identified patients that will not successfully complete the SBT at 30 minutes with a specificity of 98%. CONCLUSIONS In unselected mechanically ventilated patients, the Weaning Index is helpful to early identify patients who will fail the SBT during a first and a second trial.
Collapse
Affiliation(s)
- Jean-Luc Baudel
- Medical Resuscitation Service, Saint-Antoine Hospital, Paris, France
| | - Vincent Dubee
- Medical Resuscitation Service, Saint-Antoine Hospital, Paris, France.,Sorbonne-Pierre et Marie Curie University, Paris, France
| | - Pierre-Yves Boelle
- Sorbonne-Pierre et Marie Curie University, Paris, France.,Public Health Service, Saint-Antoine Hospital, Paris, France
| | - Simon Bourcier
- Medical Resuscitation Service, Saint-Antoine Hospital, Paris, France.,Sorbonne-Pierre et Marie Curie University, Paris, France.,Inserm U1135, Paris, France
| | - Guillaume Leblanc
- Department of Anesthesiology and Critical Care, Laval University, Québec, QC, Canada
| | - Jeremie Joffre
- Medical Resuscitation Service, Saint-Antoine Hospital, Paris, France.,Sorbonne-Pierre et Marie Curie University, Paris, France.,Inserm U970, Paris Research Cardiovascular Center, Paris, France
| | - Naike Bigé
- Medical Resuscitation Service, Saint-Antoine Hospital, Paris, France
| | - Gabriel Preda
- Medical Resuscitation Service, Saint-Antoine Hospital, Paris, France
| | - Guillaume Dumas
- Medical Resuscitation Service, Saint-Antoine Hospital, Paris, France
| | - Bertrand Guidet
- Medical Resuscitation Service, Saint-Antoine Hospital, Paris, France.,Sorbonne-Pierre et Marie Curie University, Paris, France.,Inserm U1135, Paris, France
| | - Eric Maury
- Medical Resuscitation Service, Saint-Antoine Hospital, Paris, France.,Sorbonne-Pierre et Marie Curie University, Paris, France.,Inserm U1135, Paris, France
| | - Hafid Ait-Oufella
- Medical Resuscitation Service, Saint-Antoine Hospital, Paris, France - .,Sorbonne-Pierre et Marie Curie University, Paris, France.,Inserm U970, Paris Research Cardiovascular Center, Paris, France
| |
Collapse
|
8
|
Weaning from Mechanical Ventilation in ARDS: Aspects to Think about for Better Understanding, Evaluation, and Management. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5423639. [PMID: 30402484 PMCID: PMC6198583 DOI: 10.1155/2018/5423639] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 12/14/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is characterized by severe inflammatory response and hypoxemia. The use of mechanical ventilation (MV) for correction of gas exchange can cause worsening of this inflammatory response, called “ventilator-induced lung injury” (VILI). The process of withdrawing mechanical ventilation, referred to as weaning from MV, may cause worsening of lung injury by spontaneous ventilation. Currently, there are few specific studies in patients with ARDS. Herein, we reviewed the main aspects of spontaneous ventilation and also discussed potential methods to predict the failure of weaning in this patient category. We also reviewed new treatments (modes of mechanical ventilation, neuromuscular blocker use, and extracorporeal membrane oxygenation) that could be considered in weaning ARDS patients from MV.
Collapse
|
9
|
Luo Z, Zheng Y, Yang L, Liu S, Zhu J, Zhao N, Pang B, Cao Z, Ma Y. Neutrophil/lymphocyte ratio is helpful for predicting weaning failure: a prospective, observational cohort study. J Thorac Dis 2018; 10:5232-5245. [PMID: 30416770 DOI: 10.21037/jtd.2018.08.68] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background To assess the usefulness of the neutrophil/lymphocyte ratio (NLR), a marker of inflammation and/or stress, for predicting weaning failure in patients receiving invasive mechanical ventilation (IMV), compared to levels of leukocytes and C-reactive protein (CRP). Methods This observational prospective cohort study was conducted from July 2013 to December 2016 in an intensive care unit in China, enrolling 269 consecutive patients receiving IMV. Patients underwent a spontaneous breathing trial (SBT) if they were ready to wean, and underwent extubation if they passed the SBT. The evaluated markers were measured immediately prior to SBT, and compared between weaning-failure and weaning-success patients. Receiver-operating characteristic (ROC) curve and logistic regression analyses were used to evaluate the ability of these markers to predict weaning failure. Results In all, 94 (34.9%) patients failed the weaning process (66 failed SBT and 28 presented with post-extubation respiratory distress). NLR was a better predictor of failure (area under the ROC curve, 0.69; 95% CI, 0.62-0.76) than leukocyte levels (0.60, 0.53-0.67) and CRP values (0.58, 0.51-0.65). NLR >11, leukocyte counts >10.5×109/L, and CRP >58 mg/L prior to weaning had the best combination of sensitivity (73%, 64%, and 63%, respectively), specificity (59%, 55%, and 63%), positive predictive value (49%, 43%, and 48%), negative predictive value (81%, 74%, and 76%), and diagnostic accuracy (64%, 58%, and 63%) for predicting weaning failure. However, only NLR >11 (odds ratio, 5.91; 95% CI, 3.08-11.33; P<0.001) was an independent predictor of weaning failure in the adjusted logistic regression model. Conclusions NLR may be a useful marker for predicting weaning failure, and weaning at NLR >11 might be considered with caution. Further study with a larger sample size and with weaning outcome as a variable of concern is warranted. Trial registration: ClinicalTrials.gov identifier: NCT02981589.
Collapse
Affiliation(s)
- Zujin Luo
- Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Yinyin Zheng
- Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Liu Yang
- Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Sijie Liu
- Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Jian Zhu
- Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Na Zhao
- Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Baosen Pang
- Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Zhixin Cao
- Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Yingmin Ma
- Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| |
Collapse
|
10
|
Forgiarini SGI, da Rosa DP, Forgiarini LF, Teixeira C, Andrade CF, Forgiarini LA, Felix EA, Friedman G. Evaluation of systemic inflammation in patients being weaned from mechanical ventilation. Clinics (Sao Paulo) 2018; 73:e256. [PMID: 29924185 PMCID: PMC5996438 DOI: 10.6061/clinics/2018/e256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/15/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate systemic inflammatory factors and their relation to success or failure in a spontaneous ventilation test. METHODS This cross-sectional study included a sample of 54 adult patients. Demographic data and clinical parameters were collected, and blood samples were collected in the first minute of the spontaneous ventilation test to evaluate interleukin (IL)-1β, IL-6, IL-8, and IL-10, tumour necrosis factor alpha (TNFα) and C-reactive protein. RESULTS Patients who experienced extubation failure presented a lower rapid shallow breathing index than those who passed, and these patients also showed a significant increase in C-reactive protein 48 hours after extubation. We observed, moreover, that each unit increase in inflammatory factors led to a higher risk of spontaneous ventilation test failure, with a risk of 2.27 (1.001 - 4.60, p=0.049) for TNFα, 2.23 (1.06 - 6.54, p=0.037) for IL-6, 2.66 (1.06 - 6.70, p=0.037) for IL-8 and 2.08 (1.01 - 4.31, p=0.04) for IL-10, and the rapid shallow breathing index was correlated with IL-1 (r=-0.51, p=0.04). CONCLUSIONS C-reactive protein is increased in patients who fail the spontaneous ventilation test, and increased ILs are associated with a greater prevalence of failure in this process; the rapid shallow breathing index may not be effective in patients who present systemic inflammation.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Gilberto Friedman
- Programa de Pos-Graduacao em Ciencias Pneumologicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
- *Corresponding Author. E-mail:
| |
Collapse
|
11
|
Hillas G, Perlikos F, Toumpanakis D, Litsiou E, Nikolakopoulou S, Sagris K, Vassilakopoulos T. Controlled Mechanical Ventilation Attenuates the Systemic Inflammation of Severe Chronic Obstructive Pulmonary Disease Exacerbations. Am J Respir Crit Care Med 2016; 193:696-8. [DOI: 10.1164/rccm.201508-1700le] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
12
|
Vitacca M, Scalvini S, Volterrani M, Clini EM, Paneroni M, Giordano A, Ambrosino N. In COPD patients on prolonged mechanical ventilation heart rate variability during the T-piece trial is better after pressure support plus PEEP: A pilot physiological study. Heart Lung 2014; 43:420-6. [DOI: 10.1016/j.hrtlng.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/02/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
|