Reducing Airway Occlusion Time Without Losing Accuracy to Predict Successful Mechanical Ventilator Liberation During the Measurement of the Timed Inspiratory Effort Index.

Autor: Cordeiro RCC; Medical Science Post-Graduation Program, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil., de Souza LC; Physiotherapy College, Estácio de Sá University, Niterói, Rio de Janeiro, Brazil leonardo.uti@gmail.com., Lugon JR; Medicine/Nephrology, Medical School of Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
Jazyk: angličtina
Zdroj: Respiratory care [Respir Care] 2024 Jul 24; Vol. 69 (8), pp. 953-958. Date of Electronic Publication: 2024 Jul 24.
DOI: 10.4187/respcare.11546
Abstrakt: Background: In 2013, a new predictor of successful mechanical ventilation liberation named timed inspiratory effort (TIE) index was devised with the normalization of the maximum inspiratory pressure (obtained within 60 s of unidirectional airway occlusion) with the time at which the value was reached. The aim of this study was to verify whether the presence of a sequence of a certain number of inspiratory effort values between 30-60 s > 1.0 cm H 2 O/s could predict weaning success in a performance comparable to the TIE index.
Methods: This was a retrospective observational study using 4 databases of previous studies on the TIE index. All patients receiving mechanical ventilation for ≤ 24 h were eligible. Liberation from mechanical ventilation-extubation decisions was made based on performance with spontaneous breathing trials. P < .05 was considered significant. The performance of the TIE index was evaluated by calculating the area under the receiver operating characteristics (AUROC) curve.
Results: From 349 eligible patients, 165 subjects were selected for analysis. The AUROC for the TIE index in the studied sample was 0.92 (95% CI 0.87-0.97, P < .001). A sequence of ≤ 4 inspiratory efforts > 1.0 cm H 2 O/s was found in 51.5% of the subjects, with successful ventilatory liberation occurring in 95.3%. The highest specificity values belonged to the sequence of ≤ 4 and ≤ 5 inspiratory efforts > 1.0 cm H 2 O/s; the highest positive predictive value and positive likelihood ratio belonged to the sequence of ≤ 4 inspiratory efforts > 1.0 cm H 2 O/s. The mean time that could have been spared if the procedure were interrupted after the first sequence of 4 inspiratory efforts > 1.0 cm H 2 O/s was 23 ± 3 s.
Conclusions: The presence of a sequence of ≤ 4 inspiratory efforts > 1.0 cm H 2 O/s during the TIE index measurement was a reliable predictor of weaning success, which could allow timely interruption of the procedure and entail a substantial reduction in airway occlusion time.
Competing Interests: The authors have disclosed no conflicts of interest.
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Databáze: MEDLINE
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