Weaning from mechanical ventilation: a cross-sectional study of reference values and the discriminative validity of aging

Psychosocial Predictors of Ventilator weaning Outcomes among patients in intensive care units

Background

Ventilator weaning is a process of discontinuing mechanical ventilation and transitioning patients to independent breathing after a period of mechanical support. Weaning outcomes among the critically ill in intensive care units (ICUs) vary significantly among individuals, leading to considerable variation in healthcare costs, length of hospital stay, morbidity and mortality. Addressing psychosocial aspects of care can improve weaning outcomes.

Objective

This study aimed to determine the effect of psychosocial factors (social support, family/significant other support, ability to communicate) on weaning outcome within intensive care patients. This research hypothesized that psychological and social factors play a role in determining ventilator weaning outcomes among ICU patients.

Methods

This study used a longitudinal, retrospective research design to analyze positive and negative psychosocial predictors of ventilator weaning outcomes. Data collection methods include interviews and questionnaires with patients and their families, as well as clinical data from the patient's medical records.

Results

presence of anxiety, depression, and hallucinations, have a negative relationship with weaning outcomes regarding a patient's psychological characteristics (rs = -0.207, -0.163, -0.158), while communication with a patient during mechanical ventilation have a positive relationship with weaning outcomes regarding a patient's psychological characteristics (rs = 0.152; p ≤ 0.05). Moreover patients who have fear during weaning trials, feeling neglected, and feeling insecurity have a negative relationship with weaning outcomes while gaining family support during mechanical ventilation have a positive relationship with weaning outcomes (rs = 0.144; p ≤ 0.05).Significance of results, the findings suggests that psychosocial factors, such as anxiety, depression, patient's perception of their illness, motivation to wean, and family involvement can influence the success of ventilator weaning among patients in ICUs.

Transitional Percentage of Minute Volume as a Novel Predictor of Weaning from Mechanical Ventilation in Patients with Chronic Respiratory Failure

PURPOSE

Some patients with respiratory failure fail initial weaning attempts and need prolonged mechanical ventilation (MV). Prolonged MV is associated with many complications and consumption of heathcare resources. Objective weaning indices help staffs to identify high-potential patients for weaning from the MV. Traditional weaning indices are not reliable in clinical practice. Transitional percentage of minute volume (TMV%) is a new index of the work of breathing. This study aimed to investigate the utility of TMV% in the prediction of weaning potential.

METHODS

This study was prospectively performed including all patients with prolonged MV. Researchers recorded their demographics, TMV%, respiratory parameters, Acute Physiology and Chronic Health Evaluation II score, and laboratory data upon arrival at the respiratory care center. The factors associated with successful weaning were analyzed.

RESULTS

Out of the 120 patients included, 84 (70.0%) were successfully weaned from MV. Traditional weaning indices such as rapid shallow breathing index could not predict the weaning outcome. TMV% was a valuable parameter as patients with a lower TMV%, higher tidal volume, higher hemoglobin, lower blood urea nitrogen, and lower Acute Physiology and Chronic Health Evaluation II scores had a higher rate of successful weaning. TMV%, tidal volume, and HCO3^- levels were independent predictors of successful weaning, and the area under the curve was .79 in the logistic regression model.

CONCLUSION

TMV% is a novel and effective predictor of successful weaning. Patients with lower TMV% had a higher MV weaning outcome. Once patients with a high potential for successful weaning are identified, they should be aggressively weaned from MV as soon as possible.

CLINICAL TRIALS GOVERNMENT IDENTIFIER

NCT033480.

Aging Effects on Alveolar Sacs Under Mechanical Ventilation

Alveolar sacs are primarily responsible for gas exchange in the human respiratory system and lose their functionality with aging. Three-dimensional (3D) models of young and old human alveolar sacs were constructed and fluid-solid interaction was employed to investigate the contribution of age-related changes to decline in alveolar sacs function under mechanical ventilation (MV). Simulation results illustrated that compliance and pressure reduced in the alveolar sacs of the elderly adults, and they have to work harder to breathe. Morphological changes were found to be mainly responsible for the decline in alveolar sacs function. Influence of individual differences on the alveolar sacs function was negligible and 95% confidence intervals for compliance and work of breathing (WOB) using measures from different individuals also support this finding. Moreover, higher mortality risk was recorded for elderly adults who undergo MV. Specifically, ventilator devices setting has been identified as a potential parameter for compromising respiratory function in the elderly adults. Volume-controlled ventilation applied less pressure, whereas, pressure-controlled ventilation resulted in higher compliance in the alveolar sacs and decreased WOB. Sensitivity of alveolar sacs to ventilator setting under the volume-controlled mode illustrated that increasing breathing frequency and decreasing the ratio of inhalation to exhalation times and TV caused an increase in alveolar sacs expansion and compliance in older patients. Results from this study can help clinicians to develop individualized and effective ventilator protocols and to improve respiratory function in the elderly adults.

Functional evaluation of breath: spirometry and body plethysmography comparison in people with cystic fibrosis

[Purpose] The aim of the present study was to establish up-to-date data regarding the lung function of cystic fibrosis (CF) patients. [Subjects and Methods] Forty-eight patients of both genders, with a diagnosis of CF, were recruited. As a result our sample presented, according to the GOLD criteria, 23 patients with mild lung obstruction (FEV_1%pred: 89.86), 16 patients with moderate lung obstruction (FEV_1%pred: 56.1) and 9 patients with severe obstruction (FEV_1%pred: 32.1). [Results] All patients presented normal total lung capacity followed by an important residual volume increase. [Conclusion] Our results were important to illustrate the CF patient’s lung functional status and to improve the health system strategy in treating such individuals.

Nursing Strategies for Effective Weaning of the Critically Ill Mechanically Ventilated Patient

The risks imposed by mechanical ventilation can be mitigated by nurses' use of strategies that promote early but appropriate reduction of ventilatory support and timely extubation. Weaning from mechanical ventilation is confounded by the multiple impacts of critical illness on the body's systems. Effective weaning strategies that combine several interventions that optimize weaning readiness and assess readiness to wean, and use a weaning protocol in association with spontaneous breathing trials, are likely to reduce the requirement for mechanical ventilatory support in a timely manner. Weaning strategies should be reviewed and updated regularly to ensure congruence with the best available evidence.

Maximum inspiratory pressure and rapid shallow breathing index as predictors of successful ventilator weaning

[Purpose] To investigate the predictive value of maximum inspiratory pressure (MIP) and the rapid shallow breathing index (RSBI) in a ventilator weaning protocol and to evaluate the differences between clinical and surgical patients in the intensive care unit. [Subjects and Methods] Patients aged ≥15 years who underwent orotracheal intubation for mechanical ventilation and who met the criteria of the weaning protocol were included in the study. Receiver operating characteristic (ROC) curves were calculated for the analysis of each index. [Results] Logistic regression analysis was also performed. MIP showed greater sensitivity and specificity [area under the curve (AUC): 0.95 vs. 0.89] and likelihood ratios (LR) (positive(+): 20.85 vs. 9.45; negative(−): 0.07 vs. 0.17) than RSBI in the overall sample (OS) as well as in clinical patients (CP) (AUC: 0.99 vs. 0.90; LR+: 24.66 vs. 7.22; LR-: 0.01 vs. 0.15) and surgical patients (SP) (AUC: 0.99 vs. 0.87; LR+: 9.33 vs. 5.86; LR−: 0.07 vs. 0.14). The logistic regression analysis revealed that both parameters were significantly associated with the weaning success. The MIP showed greater accuracy than the RSBI (OS: 0.93 vs. 0.85; CP: 0.98 vs. 0.87; SP: 0.93 vs. 0.87). [Conclusion] Both parameters are good predictors of successful ventilator weaning.