A Reassessment of Weaning Parameters in Patients With Spontaneous Intracerebral Hemorrhage

Abstract

Background and purpose Patients with spontaneous intracerebral haemorrhage have significant morbidity and mortality. One aspect of their care is the need for mechanical ventilation. Extubating a patient safely and efficiently is important in advancing their care; however, traditional extubation criteria using the rapid shallow breathing index and negative inspiratory force do not predict success in these patients as well as they do in other intubated patients. This study aimed to evaluate these criteria in patients with spontaneous intracerebral haemorrhage to improve the extubation success rate. Methods We conducted a retrospective chart review of patients with spontaneous intracerebral haemorrhage (sICH) who underwent spontaneous breathing trials from 2018 to 2020. Twenty-nine patients met the inclusion criteria, and of these 29, 20 had a trial of extubation. Rapid shallow breathing index (RSBI), negative inspiratory force (NIF), and cuff leak were recorded to analyze breathing parameters at the time of extubation. Patients who required reintubation were noted. Results All trials of extubation required a cuff leak. Using RSBI, patients with values <105 or <85, as the only other extubation criteria, were associated with a 70.6% and 71.4% success rate, respectively. With RSBI <105 and NIF <-25 cm water, the success rate was 88.9%. Any patient with a cuff leak that had a NIF <-30 had a success rate of 100%, regardless of RSBI. Conclusion The RSBI was not a reliable isolated measure to predict 100% extubation success. Using a NIF <-30 predicts a 100% extubation success rate if a cuff leak is present. This demonstrates that the NIF may be a more useful metric in sICH patients, as it accounts for patient participation and innate ability to draw a breath spontaneously. Future studies are warranted to evaluate further and optimize the extubation criteria in these patients.

Development and validation of a nomogram to predict the 30-day mortality risk of patients with intracerebral hemorrhage

“…However, delayed weaning may lead to increased mortality 10.3389/fnins.2022.942100 rates, complication rates, and lengths of hospital stay (Coplin et al, 2000). Traditional weaning parameters, such as the rapid shallow breathing index and negative inspiratory force, are often used as clinical indicators of mechanical ventilation (Savla et al, 2021). However, they are not always reliable in patients with brain injuries, including those who cannot achieve maximal spontaneous inspiration (dos Reis et al, 2013).…”

Predictors of extubation failure and prolonged mechanical ventilation among patients with intracerebral hemorrhage after surgery

“…Once the patients could tolerate the reduced applied airway pressure support of 5–10 cmH 2 O, an SBT was performed using a T-tube (T-piece) to assess the ability to breathe spontaneously. Simultaneously, weaning parameters, including maximal inspiratory pressure (PiMax), maximum expiratory pressure (PeMax), respiratory rate (RR), rapid shallow breathing index (RSBI), minute ventilation (VE), and tidal volume (VT) were measured by a respiratory therapist using a standardized protocol [ 9 ]. In our hospital, the cutoff points of weaning parameters were − 30 cmH 2 O for PiMax, 30 cmH 2 O for PeMax, RSBI < 105, RR < 30 breaths/min, VE < 10 L/min, and VT > 5 mL/kg.…”

Sonographic assessment of diaphragmatic thickening and excursion as predictors of weaning success in the intensive care unit: A prospective observational study

“…P0.1s is the negative pressure generated at the airway opening, 100 millisecond after initiation of an inspiratory effort against an occluded airway; for mechanically ventilated patients, values of >3 cmH 2 O are associated with increased effort. [ 9 ]…”

“…Cut-off values for weaning success in this study were RSBI <105, NIF > −20 cmH 2 O, P0.1s <3.5 cmH 2 O, DE (tidal) >1.0 cm, DE (deep breathing) > 3.0 cm, and DT f >20% based on previous studies. [ 9 10 11 12 ]…”