Cassiano Teixeira

Weaning predictors do not predict extubation failure in simple-to-wean patients.

BACKGROUNDnPredictor indexes are often included in weaning protocols and may help the intensive care unit (ICU) staff to reach expected weaning outcome in patients on mechanical ventilation.nnnOBJECTIVEnThe objective of this study is to evaluate the potential of weaning predictors during extubation.nnnDESIGNnThis is a prospective clinical study.nnnSETTINGSnThe study was conducted in 3 medical-surgical ICUs.nnnPATIENTSnFive hundred consecutive unselected patients ventilated for more than 48 hours were included.nnnMETHODS AND MEASUREMENTSnAll patients were extubated after 30 minutes of successful spontaneous breathing trial and followed up for 48 hours. The protocol evaluated hemodynamics, ventilation parameters, arterial blood gases, and the weaning indexes frequency to tidal volume ratio; compliance, respiratory rate, oxygenation, and pressure; maximal inspiratory pressure; maximal expiratory pressure; Pao(2)/fraction of inspired oxygen; respiratory frequency; and tidal volume during mechanical ventilation and in the 1st and 30th minute of spontaneous breathing trial.nnnRESULTSnReintubation rate was 22.8%, and intensive care mortality was higher in the reintubation group (10% vs 31%; P < .0001). The areas under the receiver operating characteristic curve showed that tests did not discriminate which patients could tolerate extubation.nnnCONCLUSIONnUsual weaning indexes are poor predictors for extubation outcome in the overall ICU population.

Serial measurements of f/VT can predict extubation failure in patients with f/VT ≤ 105? ☆

OBJECTIVEnTo evaluate is serial measurements of respiratory rate (frequency to tidal volume, f/VT) may predict extubation failure (EF) from mechanical ventilation in patients following a successful spontaneous breathing trial (SBT) with first measurement of f/V(T) < or = 105.nnnDESIGNnProspective cohort study.nnnSETTINGnTwo medical-surgical intensive care units.nnnPATIENTSnSeventy-three patients ventilated for more than 48 hours after successful SBT were extubated and followed up for postextubation respiratory distress during 48 hours.nnnRESULTSnExtubation failure occurred in 16 (21.9%) of 73 patients. Factors such as age, sex, Apache II score, days on mechanical ventilation, respiratory failure cause, and hemodynamic or ventilatory parameters did not predict EF. Patients were evaluated during 120 minutes of SBT, and f/V(T) was measured at the 1st minute (f/V(T-1)), 30th minute (f/V(T-30)), and 120th minute (f/V(T-120)). The f/V(T-30) increased as compared with f/V(T-1) (79 +/- 24 vs 68 +/- 30, P = .01) but did not differ from f/V(T-120) (79 +/- 44 vs 81 +/- 42, P = .79). The f/V(T-1) was lower in successful extubation (ES) as compared with EF patients (62 +/- 29 vs 82 +/- 15, P = .01), and this difference was unchanged during the trial (f/V(T-30): ES [63 +/- 22] vs EF [85 +/- 24], P = .02; and f/V(T-120): ES [65 +/- 26] vs EF [88 +/- 20], P = .01)].nnnCONCLUSIONSnSerial f/V(T) measurements during 120 minutes of SBT were unable to detect EF in patients following a successful SBT with initial f/V(T) lower than 105.