BACKGROUND: Mechanical ventilation is a life-support therapy that can be associated with respiratory muscle dysfunction that may perturb the weaning process. The timed inspiratory effort (TIE) index is a recently proposed weaning index that has been reported to be effective in predicting successful weaning. We sought to analyze the respiratory muscle groups involved with the TIE index measurement utilizing the surface electromyography (sEMG). METHODS: We conducted a prospective observational study including 46 mechanically ventilated subjects. The variable analyzed with sEMG was the root mean square (RMS) for correlation with the degree of recruitment of motor units and strength. The data were obtained along the 60 s of the TIE index measurement and analyzed in each one of the 3 20-s intervals. Pooled and individual muscle RMS values were analyzed comparing success and failure groups. P < .05 was considered significant. RESULTS: The median (interquartile range) age of the participants was 80 (71-87) y. The pooled sEMG data showed that muscle strength increased over time, following the profile observed for maximum inspiratory pressure, irrespective of the analyzed group. However, in line with the findings regarding maximum inspiratory pressure, the RMS medians were statistically higher at every 20-s interval in the success group. Diaphragm strength increased over time, with values reaching statistically significant differences at the end of the observation period, but only in the success group. In addition, diaphragm strength was statistically higher during the whole test in the success group. Finally, there was a substantial increase in sternocleidomastoid strength over time after 40 s of observation, which was not observed in the scalene muscles. CONCLUSIONS: Subjects succeeding in a weaning trial had higher muscle strength, confirmed in the pooled and the individual sEMG analysis. A vigorous diaphragm with low fatigue potential seems essential for successful weaning; the sternocleidomastoid may also be of importance in this regard.
BACKGROUND: Prolonged ventilatory weaning may expose patients to unnecessary discomfort, increase the risk of complications, and raise the costs of hospital treatment. In this scenario, indexes that reliably predict successful liberation can be helpful. OBJECTIVE: To evaluate the intra-and interobserver reproducibility of the timed inspiratory effort index as a weaning predictor. METHODS: This prospective observational study included subjects judged as able to start liberation from mechanical ventilation. For the intra-observer analysis, the same investigator performed 2 measurements in each selected patient with an interval of 30 min a rest. For interobserver analysis, 2 measurements were obtained in another sample of subjects, also with an interval of 30 min rest, but each of one performed by a different investigator. The Bland-Altman diagram, the coefficient concordance of kappa, and the Pearson correlation coefficient were used to compare the measurements. The performance of the timed inspiratory effort index was assessed by receiver operating characteristic curves. Values of P < .05 were considered significant. RESULTS: We selected 113 subjects (43 males; mean 6 SD age, 77 6 14 y). Fifty-six (49.6%) achieved successful liberation, and 33 (29%) died in the ICU. The mean 6 SD duration of mechanical ventilation was 14.4 6 6.7 d. The Bland-Altman diagrams that addressed intra-and interobservers agreement showed low variability between measurements. Values of the concordance coefficients of kappa were 0.82 (0.68-0.95) and 0.80 (0.65-0.94), and of the linear correlation coefficients, 0.86 (0.77-0.91) and 0.89 (0.82-0.93) for the intra-and interobservers measurements, respectively. The mean 6 SD values for the area under the curve for each pair of the intra-and interobserver measurements were 0.96 6 0.07 versus 0.94 6 0.07 (P 5 .41) and 0.94 6 0.05 versus 0.90 6 0.07 (P 5 .14), respectively. CONCLUSIONS: The variability of the measurement of the timed inspiratory effort index by intra-and interobservers showed very high reproducibility, which reinforced the index as a sensible, accurate, and reliable outcome predictor of liberation from mechanical ventilation.
The “timed inspiratory effort” (TIE) index, a new predictor of weaning outcome, normalizes the maximal inspiratory pressure with the time required to reach this value up to 60 s, incorporating the time domain into the assessment of inspiratory muscle function. The objective of this study was to determine whether the TIE predicts successful extubation at a similar rate as the T-piece trial with less time required. A non-inferiority randomized controlled trial was performed with ICU subjects eligible for weaning. The participants were allocated to the TIE or the T-piece groups. The primary outcome was successful weaning, and the main secondary outcome was ICU mortality. Eighty participants of each group were included in the final analysis. Time from the start of a successful test to effective extubation was significantly lower in the TIE group than in the T-piece group, 15 (10 to 24) vs 55 (40 to 75) min, P<0.001. In the Kaplan-Meier analysis, no significant differences were found in successful weaning (79.5 vs 82.5%, P=0.268) or survival rate (62.9 vs 53.8%, P=0.210) between the TIE and T-piece groups at the 30th day. In this preliminary study, the TIE index was not inferior to the T-piece trial as a decision-making tool for extubation and allowed a reduction in the decision time.
Background: During the COVID-19 pandemic the application of awake prone position (PP) in subjects has been describing such as a new procedures in combating the acute hypoxemic. Aim: Evaluate the efficacy of the awake PP in patients with hypoxemic respiratory failure by COVID-19 to avoid mechanical ventilation (MV). Methods: a clinical study. The subjects who were showing signs of hypoxemic respiratory failure were divided into two groups: the intervention group receiving treatment with oxygen therapy plus awake PP, and the control group only oxygen therapy. The primary outcome was the success to avoid the MV, and secondary outcomes were complications, length of stay and mortality rate in the ICU. Results: Thirty-two subjects underwent the PP in the Intervention group, and 35 maintained the conventional treatment with the oxygen therapy in the control group. The mean of the clinical variables analyzed did not show difference when comparing the groups. The rate of need of invasive mechanical ventilation (60% vs. 41%, P=0.18) and death rate (29% vs. 13%, P=0.29) was higher in the control group; however statistical diferences not were found. In the Kaplan-Meyer curves, the awake PP presented a tendency of reduction in mortality rate (15%), P=0.29 and presented a tendency of increase (30%) successful to avoid MV, P=0.16. Conclusion:The present study despite demonstrating that a simple procedure seems to contribute with a success rate to avoid the mechanical ventilator, however we cannot affirm this result. Lastly, we suggest that news RCT studies be carried out to confirm this find.
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