The optimum timing to wean invasive ventilation for patients with AECOPD or COPD with pulmonary infection

Song, Yuanlin; Chen, Rongchang; Zhan, Qingyuan; Chen, Shujing; Luo, Zujin; Ou, Jiaxian; Wang, Chen

doi:10.2147/copd.s96541

Cited by 16 publications

(15 citation statements)

References 63 publications

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“…Muscle dysfunction can also be suggested by a poor quality of sleep in the absence of sleep apnea syndrome. As already mentioned, difficulties in the weaning process in COPD patients requiring mechanical ventilation may also indicate respiratory muscle dysfunction (62). Tachypnea, is also suggestive, especially if the respiratory frequency is very high and is accompanied by shallow breathing.…”

Section: Clinical History and Physical Examinationmentioning

confidence: 92%

Clinical management of chronic obstructive pulmonary disease patients with muscle dysfunction

et al. 2016

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Muscle dysfunction is frequently observed in chronic obstructive pulmonary disease (COPD) patients, contributing to their exercise limitation and a worsening prognosis. The main factor leading to limb muscle dysfunction is deconditioning, whereas respiratory muscle dysfunction is mostly the result of pulmonary hyperinflation. However, both limb and respiratory muscles are also influenced by other negative factors, including smoking, systemic inflammation, nutritional abnormalities, exacerbations and some drugs. Limb muscle weakness is generally diagnosed through voluntary isometric maneuvers such as handgrip or quadriceps muscle contraction (dynamometry); while respiratory muscle loss of strength is usually recognized through a decrease in maximal static pressures measured at the mouth. Both types of measurements have validated reference values. Respiratory muscle strength can also be evaluated determining esophageal, gastric and transdiaphragmatic maximal pressures although there is a lack of widely accepted reference equations. Non-volitional maneuvers, obtained through electrical or magnetic stimulation, can be employed in patients unable to cooperate. Muscle endurance can also be assessed, generally using repeated submaximal maneuvers until exhaustion, but no validated reference values are available yet. The treatment of muscle dysfunction is multidimensional and includes improvement in lifestyle habits (smoking abstinence, healthy diet and a good level of physical activity, preferably outside), nutritional measures (diet supplements and occasionally, anabolic drugs), and different modalities of general and muscle training.

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Section: Clinical History and Physical Examinationmentioning

confidence: 92%

Clinical management of chronic obstructive pulmonary disease patients with muscle dysfunction

et al. 2016

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“…In such cases, strategies should be implemented to discontinue IV as soon as possible to avoid time-dependent complications that may arise as a result of prolonged IV. 4 Furthermore, extubation failure is associated with a risk of mortality, ranging from 40 to 50%. 5 …”

Section: Introductionmentioning

confidence: 99%

Role of diaphragmatic rapid shallow breathing index in predicting weaning outcome in patients with acute exacerbation of COPD

Abbas

Embarak

Walaa

et al. 2018

COPD

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BackgroundThe diaphragmatic rapid shallow breathing index (D-RSBI), which is the ratio between respiratory rate (RR) and the ultrasonographic evaluation of diaphragmatic displacement (DD), is a new and promising tool to predict weaning outcome. Its accuracy in predicting weaning failure, in ready-to-wean acute exacerbation COPD (AECOPD) patients, needs to be evaluated.Patients and methodsA prospective observational study was carried out on ready-to-wean AECOPD patients. During a T-tube spontaneous breathing trial (SBT) evaluation of the right hemidiaphragm displacement (ie, DD), M-mode ultrasonography to calculate the D-RSBI, as well as the RSBI (RR/tidal volume [VT]) were carried out simultaneously. Outcome of the weaning trial was recorded. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic accuracy of D-RSBI and RSBI.ResultsA total of 50 AECOPD patients requiring mechanical ventilation for more than 48 h who were ready to perform a SBT were included. Of these, 37 (74%) were successfully liberated from mechanical ventilation. Among the 13 patients who failed the weaning trial, 8 (62%) failed the SBT and reconnected to the ventilator, 2 (15%) were reintubated within 48 h of extubation and 3 (23%) required NIV support within 48 h of extubation. The areas under the ROC curves for D-RSBI and RSBI were 0.97 (p<0.001) and 0.67 (p<0.06), respectively.ConclusionD-RSBI (RR/DD) is superior to the traditional RSBI (RR/VT) in predicting weaning outcome in AECOPD patients.

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“…Several studies confirmed that the PIC window was more feasible to adapt in the treatment of the patient with obvious bronchial pulmonary infection, and for those who are not affected significantly by pulmonary infection still can be applied by 2 hours spontaneous breathing trial (SBT-2). [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

“…Despite of the longer time of invasive ventilation in SBT-2 and similar morbidity rate in both groups, SBT-2 was considered as an optimal timing based on a higher success rate and a lower risk of tracheal reintubation. In the present study, given that these patients were in a severe condition and their pulmonary infection would be worsening, the PIC window was regarded as a better option according to the studies by Wang et al and Song et al [ 18 , 19 ] Further data must be collected.…”

Section: Discussionmentioning

confidence: 99%

The benefit of daily sputum suction via bronchoscopy in patients of chronic obstructive pulmonary disease with ventilators

Qiao¹,

Yu²,

et al. 2018

Medicine

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Background:To compare the clinical values of bronchoscopic sputum suction and general sputum suction in respiratory failure patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with sequential invasive–noninvasive mechanical ventilation at the pulmonary infection control (PIC) window (period of lower sputum production, with thinner viscosity and lighter color, and alleviated clinical signs of infection).Methods:Patients with AECOPD-induced respiratory failure received orotracheal intubation mechanical ventilation and were randomly divided into bronchoscopic sputum suction group or general sputum suction group, and who were then treated with sequential invasive–noninvasive mechanical ventilation at PIC window (both groups). Baseline data, postoperative blood gas conditions, and postoperative clinical parameters of the patients such as appearance of PIC window, time of invasive ventilation, total time of ventilation, hospital stay, weaning success rate, reintubation rate, ventilator-associated pneumonia (VAP) incidence, and fatality rate were measured to compare the effect of 2 different ways of sputum suction.Results:There was no significant difference in baseline characteristics, postoperative blood gas conditions, between 2 groups (all P > .05). Nevertheless, the bronchoscopic sputum suction group showed earlier appearance of PIC window, shorter time of invasive ventilation, total time of ventilation and hospital stay, lower reintubation rate, VAP incidence and fatality rate, and higher weaning success rate than the general sputum suction group (all P < .05).Conclusion:Bronchoscopic sputum suction combined with sequential invasive–noninvasive mechanical ventilation at PIC window showed clinical effects in treating respiratory failure patients with AECOPD.

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The optimum timing to wean invasive ventilation for patients with AECOPD or COPD with pulmonary infection

Cited by 16 publications

References 63 publications

Clinical management of chronic obstructive pulmonary disease patients with muscle dysfunction

Clinical management of chronic obstructive pulmonary disease patients with muscle dysfunction

Role of diaphragmatic rapid shallow breathing index in predicting weaning outcome in patients with acute exacerbation of COPD

The benefit of daily sputum suction via bronchoscopy in patients of chronic obstructive pulmonary disease with ventilators

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