The predictive value of airway occlusion pressure at 100 msec (P0.1) on successful weaning from mechanical ventilation: A systematic review and meta-analysis

Sato, Ryota; Hasegawa, Daisuke; Hamahata, Natsumi; Narala, Swetha; Nishida, Kazuki; Takahashi, Kunihiko; Sempokuya, Tomoki; Daoud, Ehab

doi:10.1016/j.jcrc.2020.09.030

Cited by 16 publications

(7 citation statements)

References 42 publications

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“…Fue inicialmente descrita por Whitelaw et al en 1975 en personas sanas [41] y luego comenzó a utilizarse en pacientes críticos [42,43]. Actualmente sigue siendo foco de estudio [44][45][46]. Además es una herramienta que se utiliza para predecir el destete de la ventilación mecánica y para ajustar el soporte respiratorio, incluso en pacientes con soporte vital extracorpóreo [47].…”

Section: Presión De Oclusión De Vía Aéreaunclassified

Respiratory drive, inspiratory effort, and work of breathing: review of definitions and non-invasive monitoring tools for intensive care ventilators during pandemic times

Ríos-Castro

González-Seguel

Molina

2022

Medwave

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Technological advances in mechanical ventilation have been essential to increasing the survival rate in intensive care units. Usually, patients needing mechanical ventilation use controlled ventilation to override the patient’s respiratory muscles and favor lung protection. Weaning from mechanical ventilation implies a transition towards spontaneous breathing, mainly using assisted mechanical ventilation. In this transition, the challenge for clinicians is to avoid under and over assistance and minimize excessive respiratory effort and iatrogenic diaphragmatic and lung damage. Esophageal balloon monitoring allows objective measurements of respiratory muscle activity in real time, but there are still limitations to its routine application in intensive care unit patients using mechanical ventilation. Like the esophageal balloon, respiratory muscle electromyography and diaphragmatic ultrasound are minimally invasive tools requiring specific training that monitor respiratory muscle activity. Particularly during the coronavirus disease pandemic, non invasive tools available on mechanical ventilators to monitor respiratory drive, inspiratory effort, and work of breathing have been extended to individualize mechanical ventilation based on patient’s needs. This review aims to identify the conceptual definitions of respiratory drive, inspiratory effort, and work of breathing and to identify non invasive maneuvers available on intensive care ventilators to measure these parameters. The literature highlights that although respiratory drive, inspiratory effort, and work of breathing are intuitive concepts, even distinguished authors disagree on their definitions.

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Section: Presión De Oclusión De Vía Aéreaunclassified

Respiratory drive, inspiratory effort, and work of breathing: review of definitions and non-invasive monitoring tools for intensive care ventilators during pandemic times

Ríos-Castro

González-Seguel

Molina

2022

Medwave

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“…Therefore, ventilator discontinuation should be considered as soon as the cause of respiratory failure is improved. However, despite the fact that various evaluation systems are available for clinical practice (da Silva Neto et al, 2020;Vu et al, 2020;Sato et al, 2021), the rate of weaning failure remains as high as 20%-54% (Burns et al, 2021;Zhao et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…The commonly used evaluation indicators in clinical practice include P0.1 (Sato et al, 2021), rapid shallow breathing index (RSBI) (Souza and Lugon, 2015), inspiratory negative pressure (INF) (Vu et al, 2020), and ultrasound (Qian et al, 2018;Sharma et al, 2018). But in fact, it is difficult to continuously monitor the ventilation distribution of patients with these indicators.…”

Section: Introductionmentioning

confidence: 99%

Pendelluft as a predictor of weaning in critically ill patients: An observational cohort study

Wang

Ning

et al. 2023

Front. Physiol.

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Objective: Weaning failure is associated with adverse clinical outcomes. This study aimed to evaluate the accuracy of pendelluft during the spontaneous breathing trials (SBT) as a predictor of weaning outcome of patients with mechanical ventilation.Methods: An observational cohort study included 60 critically ill patients who were eligible for extubation. Pendelluft and electrical activity of the diaphragm (Edi) were monitored at baseline and every 10 minutes for the first 30 min of SBT denoted as T0, T1, T2, and T3. The pendelluft was measured using electrical impedance tomography (EIT), and Edi parameters were collected by Edi catheter. Patients were followed up after extubation and were divided into success group and failure group. Pendelluft, Edi parameters, respiratory parameters, and clinical outcomes such as intensive care units (ICU) stay, mortality, and 28-day ventilator-free days were compared between the two groups. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of pendelluft to predict weaning outcome.Results: Fifty patients (50/60) were successfully weaned from the machine and 10 (10/60) failed, with weaning failure rate of 16.7%. Respiratory parameters such as rapid shallow breathing index (RSBI), respiratory rate (RR) and Edi parameters such as maximum value of Edi (Edimax), Edi variation between a maximum and minimum(ΔEdi) in the failure group were higher than those in the success group. The ICU stay and the 28-day ventilator-free days in the failure group were significantly longer than those in the success group. The 28-day mortality rate was higher in the failure group. The pendelluft mainly occurred in the early stage of SBT. Ventral pendelluft and total pendelluft in the failure group were higher than those in the success group at T1. Edimax and ΔEdi were positively correlated with pendelluft. The area under ROC curve (AUC) showed moderate predictive ability for ventral pendelluft in predicting weaning failure at T1 (AUC 0.76, 95% CI 0.58–0.94, cut-off value > 3% global tidal variation).Conclusion: Pendelluft is one of the factors leading to weaning failure, which may be related to diaphragm function. Measuring pendelluft volume maybe helpful to predict weaning.

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“…Recently, a predictive model was introduced to enhance the ability of personalized factors to predict outcomes. However, the predictive model for extubation outcomes has been studied in preterm newborns and adults ( 13 , 14 ) but not in the pediatric population. At present, noninvasive respiratory support is commonly used to facilitate extubation in patients.…”

Section: Introductionmentioning

confidence: 99%

Predictive parameters and model for extubation outcome in pediatric patients

et al. 2023

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BackgroundProlonged mechanical ventilation is associated with significant morbidity in critically ill pediatric patients. In addition, extubation failure and deteriorating respiratory status after extubation contribute to increased morbidity. Well-prepared weaning procedures and accurate identification of at-risk patients using multimodal ventilator parameters are warranted to improve patient outcomes. This study aimed to identify and assess the diagnostic accuracy of single parameters and to develop a model that can help predict extubation outcomes.Materials and methodsThis prospective observational study was conducted at a university hospital between January 2021 and April 2022. Patients aged 1 month to 15 years who were intubated for more than 12 h and deemed clinically ready for extubation were enrolled. A weaning process with a spontaneous breathing trial (SBT), with or without minimal setting, was employed. The ventilator and patient parameters during the weaning period at 0, 30, and 120 min and right before extubation were recorded and analyzed.ResultsA total of 188 eligible patients were extubated during the study. Of them, 45 (23.9%) patients required respiratory support escalation within 48 h. Of 45, 13 (6.9%) were reintubated. The predictors of respiratory support escalation consisted of a nonminimal-setting SBT [odds ratio (OR) 2.2 (1.1, 4.6), P = 0.03], >3 ventilator days [OR 2.4 (1.2, 4.9), P = 0.02], occlusion pressure (P0.1) at 30 min ≥0.9 cmH2O [OR 2.3 (1.1, 4.9), P = 0.03], and exhaled tidal volume per kg at 120 min ≤8 ml/kg [OR 2.2 (1.1, 4.6), P = 0.03]; all of these predictors had an area under the curve (AUC) of 0.72. A predictive scoring system to determine the probability of respiratory support escalation was developed using a nomogram.ConclusionThe proposed predictive model, which integrated both patient and ventilator parameters, showed a modest performance level (AUC 0.72); however, it could facilitate the process of patient care.

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The predictive value of airway occlusion pressure at 100 msec (P0.1) on successful weaning from mechanical ventilation: A systematic review and meta-analysis

Cited by 16 publications

References 42 publications

Respiratory drive, inspiratory effort, and work of breathing: review of definitions and non-invasive monitoring tools for intensive care ventilators during pandemic times

Respiratory drive, inspiratory effort, and work of breathing: review of definitions and non-invasive monitoring tools for intensive care ventilators during pandemic times

Pendelluft as a predictor of weaning in critically ill patients: An observational cohort study

Predictive parameters and model for extubation outcome in pediatric patients

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