Epidemiology of Weaning Outcome according to a New Definition. The WIND Study

Béduneau, G.; Pham, Tài; Schortgen, Frédérique; Piquilloud, Lise; Zogheib, Élie; Jonas, Maud; Grelon, Fabien; Runge, Isabelle; Terzi, Nicolas; Grangé, Steven; Barberet, Guillaume; Guitard, Pierre-Gildas; Frat, Jean‐Pierre; Constan, Adrien; Chrétien, Jean-Marie; Mancebo, Jordi; Mercat, Alain; Richard, Jean-Christophe M.; Brochard, Laurent

doi:10.1164/rccm.201602-0320oc

Cited by 319 publications

(337 citation statements)

References 20 publications

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“…This limitation is shared by other studies, 9,15 because the closer one gets to the objective of 5-10% extubation failure, 7 the more difficult it is to demonstrate the efficacy of a novel strategy to challenge high-quality standard care. However, the WIND study 27 (the most recent large observational cohort in France to be published) found that the usual extubation failure rate was 18.4%, confirming that the present cohort is an outlier in this regard. This could be explained by the inclusion criteria of the present study rather than a center effect, because those without CPF assessment before extubation could have had a higher extubation failure rate than those included, and therefore the extubation failure rate of the study ICU could be closer to that reported previously.…”

Section: Limitations Of This Studysupporting

confidence: 74%

“…23 This study was not restricted to a particular group of subjects according to the complexity of their weaning process. However, although the population was not formally described according to the more recently published "separation attempt," 27 an indirect comparison can be made. Half of the population had a CPF assessment for the first separation attempt, and the median value of mechanical ventilation was 5 d, indicating that at least half were part of the group 2 (Ͻ1 week of weaning process).…”

Section: Limitations Of This Studymentioning

confidence: 99%

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Predicting Extubation Outcome by Cough Peak Flow Measured Using a Built-in Ventilator Flow Meter

et al. 2017

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BACKGROUND: Successful weaning from mechanical ventilation depends on the patient's ability to cough efficiently. Cough peak flow (CPF) could predict extubation success using a dedicated flow meter but required patient disconnection. We aimed to predict extubation outcome using an overall model, including cough performance assessed by a ventilator flow meter. METHODS: This was a prospective observational study conducted from November 2014 to October 2015. Before and after a spontaneous breathing trial, subjects were encouraged to cough as strongly as possible before freezing the ventilator screen to assess CPF and tidal volume (V T ) in the preceding inspiration. Early extubation success rate was defined as the proportion of subjects not re-intubated 48 h after extubation. Diagnostic performance of CPF and V T was assessed by using the area under the curve of the receiver operating characteristic curve. Cut-off values for CPF and V T were defined according to median values and used to describe the performance of a predictive test combining them with risk factors of early extubation failure. RESULTS: Among 673 subjects admitted, 92 had a cough assessment before extubation. For the 81 subjects with early extubation success, the median CPF was ؊67.7 L/min, and median V T was 0.646 L. For the 11 subjects with early extubation failure, the median CPF was ؊57.3 L/min, and median V T was 0.448 L. Area under the curve was 0.61 (95% CI 0.37-0.83) for CPF and 0.64 (95% CI 0.42-0.84) for CPF/V T combined. After dichotomization (CPF < ؊60 L/min or V T > 0.55 L), there was a synergistic effect to predict early extubation success (P < .001). The predictive value of success reached 94.2% for CPF/V T combined. The overall model including pH before extubation < 7.45 reached a 66.7% predictive value of failure. CONCLUSIONS: CPF measured using the flow meter of an ICU ventilator was able to predict extubation success and to build a composite score to predict extubation failure. The results were close to that found in previous studies that used a dedicated flow meter. This could help to identify high-risk subjects to prevent extubation failure. (ClinicalTrials.gov registration NCT02847221.)

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Section: Limitations Of This Studysupporting

confidence: 74%

Section: Limitations Of This Studymentioning

confidence: 99%

Predicting Extubation Outcome by Cough Peak Flow Measured Using a Built-in Ventilator Flow Meter

et al. 2017

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“…During the weaning phase, patient effort progressively increases until all the inspiratory work is generated by the patient and none by the ventilator. Most patients do not present weaning problems, while others result difficult to wean; prolonged weaning is associated with worst clinical outcomes and increased costs [8][9][10][11]. Weaning failure is attributable to different causes, which include respiratory pump insufficiency, cardiovascular dysfunction or underlying infection [12].…”

Section: Introductionmentioning

confidence: 99%

Occurrence of pendelluft under pressure support ventilation in patients who failed a spontaneous breathing trial: an observational study

Coppadoro

Grassi

Giovannoni

et al. 2020

Ann. Intensive Care

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Background: Pendelluft, the movement of gas within different lung regions, is present in animal models of assisted mechanical ventilation and associated with lung overstretching. Due to rebreathing of CO 2 as compared to fresh gas, pendelluft might reduce ventilatory efficiency possibly exacerbating patient's respiratory workload during weaning. Our aim was to measure pendelluft by electrical impedance tomography (EIT) in patients who failed a spontaneous breathing trial (SBT).Methods: This is an observational study conducted in a general intensive care unit of a tertiary-level teaching hospital. EIT signal was recorded in 20 patients while pressure support (PS) ventilation was progressively reduced from clinical level (baseline) to 2 cmH 2 O, as in an SBT; four ventral-to-dorsal lung regions of interest were identified for pendelluft measurement. A regional gas movement (> 6 mL) occurring in a direction opposite to the global EIT signal was considered diagnostic for high pendelluft.Results: Eight patients out of 20 (40%) were classified as high-pendelluft; baseline clinical characteristics did not differ between high-and low-pendelluft patients. At PS reduction, pendelluft and EtCO 2 increased more in the highpendelluft group (p < .001 and .011, respectively). The volume of gas subject to pendelluft moved almost completely from the ventral towards the dorsal lung regions, while the opposite movement was minimal (16.3 [10:32.8] vs. 0 [0:1.8] mL, p = .001). In a subgroup of patients, increased pendelluft volumes positively correlated with markers of respiratory distress such as increased respiratory rate, p0.1, and EtCO 2 . Conclusions: Occult pendelluft can be measured by EIT, and is frequently present in patients failing an SBT. When present, pendelluft increases with the reduction of ventilator support and is associated with increased EtCO 2 , suggesting a reduction of the ability to eliminate CO 2 .

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“…Decreasing the duration of invasive mechanical ventilation by early safe extubation is a major clinical goal in intensive care unit (ICU) [1]. Prolonged intubation increases the risk of ventilator-induced lung injury, ventilator-induced diaphragm dysfunction, myopathy and infections.…”

Section: Editorialmentioning

confidence: 99%

“…Prolonged intubation increases the risk of ventilator-induced lung injury, ventilator-induced diaphragm dysfunction, myopathy and infections. Nonetheless, patients’ management in the post-extubation period can be challenging and every effort should be made to avoid re-intubation, which is associated with significantly increased morbidity and mortality [1]. …”

Section: Editorialmentioning

confidence: 99%

Respiratory support after extubation: noninvasive ventilation or high-flow nasal cannula, as appropriate

Mauri

Grasselli

Jaber

2017

Ann. Intensive Care

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Epidemiology of Weaning Outcome according to a New Definition. The WIND Study

Abstract: A new classification allows us to categorize all weaning situations. Every additional day without a weaning success after the first separation attempt increases the risk of dying.

Cited by 319 publications

References 20 publications

Predicting Extubation Outcome by Cough Peak Flow Measured Using a Built-in Ventilator Flow Meter

Predicting Extubation Outcome by Cough Peak Flow Measured Using a Built-in Ventilator Flow Meter

Occurrence of pendelluft under pressure support ventilation in patients who failed a spontaneous breathing trial: an observational study

Respiratory support after extubation: noninvasive ventilation or high-flow nasal cannula, as appropriate

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