Assessment of weaning failure in chronic obstructive pulmonary disease patients under mechanical ventilation in Zagazig University Hospitals

Ghoneim, Adel H.; Elkomy, Howida; Gad, Doaa Mostafa; Abbas, Ahmed M.

doi:10.1016/j.ejcdt.2016.01.013

Cited by 8 publications

(17 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Also, the emotional stress due to abrupt disconnection from MV can result in adrenergic response with subsequent tachycardia and increase cardiac demand. In the present study, there was statistically highly significant relation between presence of ischemic heart diseases and SBT outcome (P=0, 000), which matches with the results of Ghoneim et al 14 In the present study there was statistically significant relation between left ventricular ejection fraction (EF%) (P =0.001), left ventricular diastolic dysfunction (P = 0.000), right ventricle systolic pressure (RVSP) (P <0.001) and SBT outcome. 15 This agrees with the results of Porhomayon et al, 16 that showed that ischemic heart disease and systolic or diastolic dysfunction contributes to increase in cardiac load and weaning failure.…”

Section: From the Present Study The Following Results Were Obtainedsupporting

confidence: 91%

“…The duration of MV before SBT trial could indirectly reflect the severity of the initial injury, the progressive weakness of respiratory muscle, and the occurrence of complications, each of them may contribute to difficult weaning. There was no statistically significant relation between history of previous mechanical ventilation and SBT outcome (P=0.237).The results of Ghoneim et al, 14 however showed that weaning failure was more evident in patients who were previously mechanically ventilated (p=0.032).…”

Section: From the Present Study The Following Results Were Obtainedmentioning

confidence: 84%

“…There was no statistically significant relation between SBT outcome and patients' age (p= 0.453), or gender (p =1). The study of Ghoneim et al, 14 which was carried out at the Respiratory Intensive Care Unit of Chest Department, Zagazig University Hospitals, showed that there was no significant effect of the age or gender (p=0.68) on the weaning outcome. The severity of the underlying disease and the general condition of the patients were much more determinant factors of the weaning outcome than the age or gender.…”

Section: From the Present Study The Following Results Were Obtainedmentioning

confidence: 98%

See 2 more Smart Citations

Using echocardiography and chest ultrasound for guidance of management of difficult-to-wean COPD patients

Moteleb¹

2018

JCCR

View full text Add to dashboard Cite

show abstract

Section: From the Present Study The Following Results Were Obtainedsupporting

confidence: 91%

Section: From the Present Study The Following Results Were Obtainedmentioning

confidence: 84%

Section: From the Present Study The Following Results Were Obtainedmentioning

confidence: 98%

See 1 more Smart Citation

Using echocardiography and chest ultrasound for guidance of management of difficult-to-wean COPD patients

Moteleb¹

2018

JCCR

View full text Add to dashboard Cite

show abstract

“…We found that the threshold of ≤85 breaths/min/L yielded the optimal sensitivity, specificity, PPV, NPV, LR+ and LR− for extubation success, with an AUC of 0.91. Elsewhere it has been reported that the percentage of successful weaning COPD patients rose from 34% to 60% by applying the RSBI threshold of <85 rather than <105 breaths/min/L (20). Similarly, a Taiwanese study reported the optimal RSBI threshold for COPD to be <79 breaths/min/L (21).…”

Section: Extubation Successmentioning

confidence: 99%

“…This has prompted some to call for more sophisticated parameters, or illness specific discriminatory thresholds for COPD patients (14,15,19). Some studies have advocated that a lower RSBI threshold may perform more optimally (20)(21)(22)(23)(24)(25)(26)(27).…”

Section: Introductionmentioning

confidence: 99%

A rapid shallow breathing index threshold of 85 best predicts extubation success in chronic obstructive pulmonary disease patients with hypercapnic respiratory failure

Goharani¹,

Vahedian‐Azimi²,

Galal³

et al. 2019

J. Thorac. Dis

View full text Add to dashboard Cite

Background: The rapid shallow breathing index (RSBI) is used clinically to help predict a patient's likelihood of successful liberation from mechanical ventilation (MV). However, the traditional threshold (<105 breaths/min/L) may underperform in patients with chronic obstructive pulmonary disease (COPD).We sought to determine the optimal RSBI threshold for COPD patients to improve the diagnostic accuracy for predicting successful ventilator liberation. Methods: This was a prospective observational multicenter study of COPD patients [according to Global initiative for Chronic Obstructive Lung Disease (GOLD) criteria] admitted to the Medical ICUs of eight academic medical centers. All patients were intubated for hypercapnic respiratory failure and met the American Thoracic Society/European Respiratory Society guidelines to participate in a weaning trial. Ventilator weaning was conducted according to a defined protocol. RSBI was measured through the ventilator after 120 minutes of spontaneous breathing trial (SBT). Results: Ninety patients were included (39 males and 51 females). Forty-three patients (48%) were successfully extubated whereas 47 patients (52%) failed extubation. Significant differences were observed between groups for duration-of-intubation [duration of intubation (DoI); P<0.0001], spontaneous tidal volume (VT) (P=0.03), and the ratio of dynamic-to-static compliance (P=0.005). The RSBI threshold of ≤85 breaths/min/L performed best: area under curve (AUC) receiver operating characteristic (ROC) curves 0.91, sensitivity 95.6%, specificity 90.4%, positive predictive value (PPV) 95.5%, and negative predictive value (NPV) 90.6%., positive likelihood ratio (LR+) 5.48, negative likelihood ratio (LR−) 0.25, and the diagnostic accuracy 91.7%. In post-ROC analyses, DoI and hospital length-of-stay (LOS) did not impact performance. Conclusions: In COPD patients intubated with hypercapnia, RSBI ≤85 breaths/min/L outperformed the widely used threshold <105 breaths/min/L, yielding a 95.5% probability of extubation success, independent 1224

show abstract

Utilization of indirect calorimetry to assist in determining undiagnosed hypothyroidism in a patient on mechanical ventilation

Hahn

Brody

2021

Nut in Clin Prac

View full text Add to dashboard Cite

Published predictive equations are required when indirect calorimetry (IC) is unavailable in the clinical setting. Several medical conditions that are not accounted for by published predictive equations can impact a patient's resting energy expenditure, such as adrenal changes or alterations in thyroid‐stimulating hormone (TSH). TSH levels significantly impact a patient's resting energy expenditure, with hypothyroidism decreasing and hyperthyroidism increasing energy requirements. Clinical hypothyroidism has been correlated with increased ventilator dependency in patients with critical illness and malnutrition. The following case study describes the utilization of IC to trigger a full evaluation for the diagnosis of hypothyroidism in an adult patient with multiple myeloma who was mechanically ventilated. IC results for this patient were 39% lower than estimated by predictive energy equations. TSH, thyroxine, and triiodothyronine serum assays were obtained to rule out hypothyroidism. Based on elevated TSH and low thyroxine, the patient was found to have undiagnosed hypothyroidism. Appropriate pharmaceutical and nutrition interventions were made based upon these results. This case demonstrates the impact hormonal changes can have on resting energy expenditure and how the utilization of IC can provide additional information other than energy requirements.

show abstract

Assessment of weaning failure in chronic obstructive pulmonary disease patients under mechanical ventilation in Zagazig University Hospitals

Cited by 8 publications

References 37 publications

Using echocardiography and chest ultrasound for guidance of management of difficult-to-wean COPD patients

Using echocardiography and chest ultrasound for guidance of management of difficult-to-wean COPD patients

A rapid shallow breathing index threshold of 85 best predicts extubation success in chronic obstructive pulmonary disease patients with hypercapnic respiratory failure

Utilization of indirect calorimetry to assist in determining undiagnosed hypothyroidism in a patient on mechanical ventilation

Contact Info

Product

Resources

About