Bedside Criteria for Discontinuation of Mechanical Ventilation

Sahn, Steven A.; Lakshminarayan, S.

doi:10.1378/chest.63.6.1002

Cited by 316 publications

(101 citation statements)

References 4 publications

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“…Since the same method was used in both studies [12], this discrepancy probably mainly reflects differences between the populations studied. The present MIP threshold is also higher than that reported by other investigators (~30 cmH 2 O) for a nonhomogeneous patient population [11] and for a group consisting predominantly of postoperative patients with a mean duration of mechanical ventilation of 36 h [21]. Since these investigators also used the occlusion method of MARINI et al [12] to assess MIP, it is likely that the present high MIP threshold value reflects the different patient populations studied.…”

Section: Discussioncontrasting

confidence: 51%

Predictors of weaning outcome in chronic obstructive pulmonary disease patients

Alvisi¹,

Volta²,

Er³

et al. 2000

Eur Respir J

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Several threshold values for predicting weaning outcome from mechanical ventilation have been proposed. These values, however, have been obtained in nonhomogeneous patient populations. The aim of the present study was to determine the threshold values in chronic obstructive pulmonary disease (COPD) patients and compare them to those reported for nonhomogeneous patient populations.The initial weaning trial included 81 COPD patients. Fifty-three of them underwent a successful weaning trial, whereas 28 failed it. The latter were enrolled into the present investigation, and were restudied during a subsequent successful trial. The weaning indices used were those reported in the literature.The threshold values obtained were within 10% of those reported for a nonhomogeneous patients population only for tidal volume and effective compliance. The classification error was <20% for maximal inspiratory pressure (MIP), occluded inspiratory pressure swing (DPI)/MIP, rapid and shallow breathing (respiratory frequency/tidal volume), and compliance, rate, oxygenation, pressure index (CROP), whereas the area under the receiver operating characteristic curves was >0.9 only for DPI/MIP and CROP.In conclusion, the threshold values obtained in chronic obstructive pulmonary disease patients who failed the first weaning attempt differed from those previously reported. Although a gold standard weaning index is not available for chronic obstructive pulmonary disease patients, the occluded inspiratory pressure swing/ maximal inspiratory pressure and compliance, rate, oxygenation, pressure index may be candidates for such a role. Eur Respir J 2000; 15: 656±662.

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Section: Discussioncontrasting

confidence: 51%

Predictors of weaning outcome in chronic obstructive pulmonary disease patients

Alvisi¹,

Volta²,

Er³

et al. 2000

Eur Respir J

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“…39,40 The 3-day W eaning predictors once popular in the 1990s have not proven clinically useful in different populations of patients. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Additional research on the development of predictors has largely been abandoned because studies of weaning protocols with weaning screens (to test "wean ability") and trials of spontaneous breathing have indicated the effectiveness of the protocols in improving outcomes of patients treated with mechanical ventilation. [19][20][21][22][23][24][25][26] Although these methods have improved weaning outcomes in many instances, other factors such as infusion of sedatives [27][28][29] and glycemic control 30,31 have also been linked to weaning outcomes and are the focus of many institutional initiatives to ensure adherence to the related management guidelines.…”

Section: Long-term Mechanical Ventilation Initiativementioning

confidence: 99%

Multifactor Clinical Score and Outcome of Mechanical Ventilation Weaning Trials: Burns Wean Assessment Program

Burns¹,

Fisher²,

Tribble³

et al. 2010

American Journal of Critical Care

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“…5,6 Traditionally, discontinuation of mechanical ventilation and extubation were carried out tion. 7,8 This method requires clinical experience and it is nearly impossible to replicate the results and assess muscle fatigue. 7,8 Several predictors of successful termination of ventilatory support have been validated.…”

Section: Introductionmentioning

confidence: 99%

“…7,8 This method requires clinical experience and it is nearly impossible to replicate the results and assess muscle fatigue. 7,8 Several predictors of successful termination of ventilatory support have been validated. 9 In predicting a successful weaning, these predictors have good sensitivity but low specificity.…”

Section: Introductionmentioning

confidence: 99%

Preliminary Evaluation of a New Index to Predict the Outcome of a Spontaneous Breathing Trial

et al. 2011

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BACKGROUND:The available predictors of spontaneous-breathing-trial (SBT) success/failure lack accuracy. We devised a new index, the CORE index (compliance, oxygenation, respiration, and effort). OBJECTIVE: To compare the CORE index to the CROP index (compliance, rate, oxygenation, and pressure), airway-occlusion pressure 0.1 s after the start of inspiratory flow (P 0.1 ), and rapid shallow breathing index (RSBI) for predicting SBT success/failure in a critical care environment. METHODS: With 47 mechanically ventilated patients recovering from respiratory failure, of various causes, we prospectively examined the SBT success/failure prediction accuracy and calculated receiver operating characteristic curves, sensitivity, specificity, and likelihood ratios of CORE, CROP, P 0.1 , and RSBI. RESULTS: The specificities were CORE 0.

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Bedside Criteria for Discontinuation of Mechanical Ventilation

Cited by 316 publications

References 4 publications

Predictors of weaning outcome in chronic obstructive pulmonary disease patients

Predictors of weaning outcome in chronic obstructive pulmonary disease patients

Multifactor Clinical Score and Outcome of Mechanical Ventilation Weaning Trials: Burns Wean Assessment Program

Preliminary Evaluation of a New Index to Predict the Outcome of a Spontaneous Breathing Trial

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