The FIM can be used as a functional status outcome measure in people for whom weaning from mechanical ventilation is difficult.

BACKGROUND:The need for prolonged mechanical ventilation (PMV) after cardiac surgery is still a common problem. We hypothesized that subjects who required PMV after a single surgery (either coronary artery bypass grafting or valve surgery) would have better outcomes than those who had experienced both revascularization and valve surgery. METHODS: We retrospectively analyzed the characteristics and outcomes for patients consecutively admitted to our weaning unit (WU) after cardiac surgery between December 2007 and August 2012. Subjects' data were analyzed according to the number of procedures. Group 1 included subjects who had undergone a single surgery (valvular replacement or myocardial revascularization). Group 2 included subjects who had undergone combined surgery (valvular replacement and myocardial revascularization). Data for PMV subjects who were transferred to the WU for reasons other than cardiac surgery in the same period are also reported. RESULTS: Of 584 PMV subjects admitted, 35 (5.9%, 19 in group 1 and 16 in group 2) were referred after cardiac surgery. At WU admission, group 2 showed significantly more comorbidities and a greater clinical severity than group 1. Compared with group 1, group 2 showed a significantly lower weaning rate (43.7% vs 78.9%, P ‫؍‬ .003) and a higher in-hospital mortality (31.3% vs 5.3%, P ‫؍‬ .04). The overall 6-month survival for subjects of group 1 was 73.7% compared with 37.5% for subjects in group 2 (P ‫؍‬ .02). Adjusting for comorbidities and clinical severity, the difference between the 2 groups did not reach statistical significance for either the weaning rate or the overall 6-month survival. At discharge, health status, as assessed by means of functional independence measure, was significantly better in group 1 than in group 2 (P ‫؍‬ .035). CONCLUSIONS: These results suggest that patients needing PMV after combined cardiac surgery may suffer worse outcomes than those needing PMV after simple cardiac surgery.

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The aim of the present study is to analyse changes in the diaphragmatic electromyography integral, as a direct expression of the patients inspiratory effort and index of neural respiratory drive, and parameters associated with ventilatory function in patients with prolonged weaning under Pressure Support Ventilation (PSV) and Neurally Adjusted Ventilatoy Assist (NAVA). Five patients affected by neuromuscular diseases were recruited. Each patient underwent a sequence of decreasing inspiratory support levels under NAVA and PSV, randomly assigned, from a baseline to a final level. At baseline, the value of diaphragmatic electromyography integral was higher under NAVA compared to PSV and increased in both ventilation modes progressing to final level. Higher values of inspiratory time and neural inspiratory time were observed in PSV at final level compared to baseline level. Conversely, a significant decrease of neural inspiratory time from baseline level to final level was observed in NAVA. Tidal volume at final level was significantly lower than at baseline level in both ventilation modes. These preliminary results show that in prolonged weaning patients affected by neuromuscular disease NAVA ventilation is associated to a higher diaphragmatic electromyography activity compared to PSV with same level of ventilation and subjective comfort