The Integrative Weaning Index in Elderly ICU Subjects

Azeredo, Leandro M. de; Nemer, Sérgio Nogueira; Barbas, C S; Caldeira, Jefferson Braga; Noé, Rosângela Aparecida; Guimarães, Bruno; Caldas, Célia Pereira

doi:10.4187/respcare.04524

Cited by 9 publications

(7 citation statements)

References 29 publications

(50 reference statements)

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“…Furthermore, we enrolled many patients of advanced age in the present study. The causes of weaning failure in older patients are multifactorial [ 29 ], and few specific parameters are available to predict weaning outcomes in this population [ 30 ]. Therefore, diaphragmatic parameters should be combined with other parameters for predicting weaning outcomes.…”

Section: Discussionmentioning

confidence: 99%

Diaphragmatic parameters by ultrasonography for predicting weaning outcomes

et al. 2018

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BackgroundDiaphragmatic dysfunction remains the main cause of weaning difficulty or failure. Ultrasonographic measurement of diaphragmatic function can be used to predict the outcomes of weaning from mechanical ventilation. Our primary objective was to investigate the performance of various sonographic parameters of diaphragmatic function for predicting the success of weaning from mechanical ventilation.MethodsWe prospectively enrolled 68 adult patients requiring mechanical ventilation who were admitted to the intensive care unit from June 2013 to November 2013. The diaphragmatic inspiratory excursion, time to peak inspiratory amplitude of the diaphragm (TPIAdia), diaphragmatic thickness (DT), DT difference (DTD), and diaphragm thickening fraction (TFdi) were determined by bedside ultrasonography performed at the end of a spontaneous breathing trial. A receiver operating characteristic curve was used for analysis.ResultsIn total, 62 patients were analyzed. The mean TPIAdia was significantly higher in the weaning success group (right, 1.27 ± 0.38 s; left, 1.14 ± 0.37 s) than in the weaning failure group (right, 0.97 ± 0.43 s; left, 0.85 ± 0.39 s) (P < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of a TPIAdia of > 0.8 s in predicting weaning success were 92, 46, 89, and 56%, respectively. The diaphragmatic inspiratory excursion, DTD, and TFdi were associated with reintubation within 48 h. The P values were 0.047, 0.021, and 0.028, and the areas under the receiver operating characteristic curve were 0.716, 0.805, and 0.784, respectively.ConclusionAmong diaphragmatic parameters, TPIAdia exhibits good performance in predicting the success of weaning from mechanical ventilation. This study demonstrated a trend toward successful use of TPIAdia rather than diaphragmatic inspiratory excursion as a predictor of weaning from mechanical ventilation.Electronic supplementary materialThe online version of this article (10.1186/s12890-018-0739-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Diaphragmatic parameters by ultrasonography for predicting weaning outcomes

et al. 2018

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“…SPSS software (V.23.0) was used to analysis. To analyze the difference in weaning parameters between the 2 groups of patients, the adequate sample size of patients calculated from a previous study was 25 [5].…”

Section: Discussionmentioning

confidence: 99%

“…One possible explanation of our finding is that during SBT among the elderly may result in a high work load of breathing and related to higher DTF. One related study [5] in elderly demonstrated that IWI, not otherwise single parameters, was significant for predicting weaning success. This can be explained by evaluating multiple essential functions representing higher predictive performance among elderly patients.…”

Section: Discussionmentioning

confidence: 99%

“…No consensus has been reached about the influence of age on mortality [3]. Disease severity on admission, nosocomial infection, and presence of significant comorbid conditions mainly decided the patient's outcomes in compared with age alone [4,5]. However, regarding weaning from mechanical ventilation, it seems that elderly subjects were associated with difficult weaning [6].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of weaning parameters for weaning readiness from mechanical ventilation among elderly patients

2022

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Background: Numbers of elderly patients with acute respiratory failure continue to rise with increasing age of the general population worldwide. Ventilatory reserve decreases substantially with age as a result of multiple interrelated physiologic changes. Objective: This study aimed to evaluate the predictive value of conventional and composite weaning parameters among elderly patients. Methods: We conducted an observational prospective study among intubated patients ≥70 years old and readied for undergoing spontaneous breathing trial (SBT). Weaning parameters were recorded [heart rate, respiratory rate, tidal volume, minute ventilation (MV)] at 1 min, 30 min, and 2 hr after beginning of SBT. Cough peak expiratory flow (CPEF) and diaphragmatic thickness (DT) were also measured at 1 min after SBT. Weaning parameters were compared between the 2 patient groups (weaning success vs. weaning failure). Primary outcome was difference in weaning parameters between the 2 groups of patients. Results: All 48 subjects were enrolled. The mean (±SD) age was 80.2 (±6) years. Altogether, 38 patients (79.2%) were in the weaning success group and 10 patients (20.8%) in the weaning failure group. All baseline characteristics did not significantly differ between the 2 groups. While no difference was observed in other isolated weaning parameters between the 2 patient groups, we found that patients in the weaning success group had significantly lower MV than patients in the weaning failure group (8.3±1.8 vs. 9.9±2.5 L/min, p=0.025). Composite weaning parameters included MV/CPEF and MV/(CPEF x DT) increased predictive values for weaning failure than isolated MV with area under the receiver operating characteristics curves of 0.78, 0.80, and 0.72 respectively. The best cutoff point to predict weaning failure were MV ≥8.4 L/min, MV/CPEF ≥0.12, and MV/(CPEF x DT) ≥0.45 cm-1 Conclusion: MV was the only parameter associated with weaning failure among the elderly. Composite parameters demonstrated better predictive value for assessing weaning readiness among elderly patients.

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“…Embora, apenas a idade, isoladamente, não represente um preditor de mortalidade, ela pode determinar a admissão na UTI e a intensidade do tratamento. Além disso, estudos mostram que, quando comparada apenas com a idade, a gravidade da doença aguda na admissão tem mais efeito sobre a mortalidade (DIETRICH et al, 2017;NADAL et al, 2018;AZEREDO et al, 2017).…”

Section: Introductionunclassified