Comparisons of predictive performance of breathing pattern variability measured during T-piece, automatic tube compensation, and pressure support ventilation for weaning intensive care unit patients from mechanical ventilation*

Abstract

Since 100% inspiratory automatic tube compensation with 5 cm H2O positive end-expiratory pressure and 5 cm H2O pressure support ventilation with 5 cm H2O positive end-expiratory pressure reduce the predictive performance of breathing pattern variability, breathing pattern variability measurement during the T-piece trial is the best choice for predicting extubation outcome in intensive care unit patients patients.

Improvement in the Prediction of Ventilator Weaning Outcomes by an Artificial Neural Network in a Medical ICU

“…Breathing pattern during SBTs under minimal ventilatory support (eg, CPAP or PSV) may reduce the predictive performance of breathing pattern variability. 24,43 Although P I max , RSBI, RSBI 1 , RSBI 30 , and ⌬RSBI 30 were not used as the input parameters for the ANN model, the prediction performance of the ANN model was more precise than any one of them. This result may indicate that more clinical parameters from the subject should be taken into consideration during an SBT before extubation.…”

“…Breathing patterns and their variability could also be influenced by different SBT methods. 24 We collected subjects' breathing pattern parameters by conducting an SBT with a low level of pressure support, which could help specific medical ICU patients pass the SBT and also improve the success rate of extubation. 41 Moreover, the efficiency and convenience of collecting data directly from a microprocessor ventilator met one of the criteria for an ideal weaning parameter.…”

“…The subjects exhibited no acute pulmonary or neuromuscular problems or signs of increased intracranial pressure before the study, and their S pO 2 was Ն95%. In addition, subjects had to meet the following routine measurements of weaning profiles [24][25][26][27] : bed position elevated to 30°, P I max Յ Ϫ18 cm H 2 O, spontaneous breathing frequency Յ 38 breaths/min, and RSBI Յ 110 breaths/min/L. All subjects were mechanically ventilated with a Evita 4 (Dräger, Lübeck, Germany) or Galileo Gold (Hamilton Medical, Reno, Nevada) ventilator in the PSV mode to maintain a V T of ϳ10 mL/kg of ideal body weight.…”

Determining The Pressure Combination During Mechanical Ventilation that is Best Compatible with the Rapid Shallow Breathing Index Calculated in Spontaneous Ventilation

“…In the study of Bien et al (19), RSBI were performed for three 30-minute periods while the patients randomly received a T-piece, 100% inspiratory automatic tube compensation with 5 cm H 2 0 PEEP and 5 cm H 2 0 PSV with 5 cm H 2 0 PEEP. They found that T-piece trial is the best choice for predicting the extubation outcome in ICU patients.…”

Why Use Anything But a Standard Spontaneous Breathing Trial to Determine Readiness for Ventilator Discontinuation?

“…As indicated above, when all patient types are compared, the use of PSV during an SBT results in the same outcome as a T-piece. 7 In addition, the authors indicate that there have been 3 previous comparisons of PAV with PSV during SBTs, all with negative results. [8][9][10] Most importantly, the patient population they chose to study was one that generally can be rapidly discontinued from ventilatory support once weaning criteria are met.…”