scholarly journals Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 92
Author(s):  
Anna Kyriakoudi ◽  
Nikoletta Rovina ◽  
Ourania Koltsida ◽  
Eirini Kostakou ◽  
Elissavet Konstantelou ◽  
...  
Keyword(s):  
Spontaneous Breathing Trial ◽  
Rapid Shallow Breathing Index ◽  
Weaning Failure ◽  
Septic Inflammation ◽  
Long Time ◽  
Shallow Breathing ◽  
The Right ◽  
Relative Mrna Expression ◽  
Experience Difficulty ◽  
Time Point

Introduction: Septic patients undergoing mechanical ventilation (MV) often experience difficulty in weaning. Th aim of this study was to determine whether inflammatory biomarkers of sepsis could be indicative of the failure or success of spontaneous breathing trial (SBT) in these patients. Methods: Sixty-five patients on MV (42 septic and 23 intubated for other reasons) fulfilling the criteria for SBT were included in the study. Blood samples were collected right before, at the end of (30 min) and 24 h after the SBT. Serum inflammatory mediators associated with sepsis (IL-18, IL-18BP, TNF) were determined and correlated with the outcome of SBT. Results: A successful SBT was achieved in 45 patients (69.2%). Septic patients had a higher percentage of SBT failure as compared to non-septic patients (85% vs. 15%, p = 0.026), with an odds ratio for failing 4.5 times (OR = 4.5 95%CI: 1.16–17.68, p 0.022). IL-18 levels and the relative mRNA expression in serum were significantly higher in septic as compared to non-septic patients (p < 0.05). Sepsis was independently associated with higher serum IL-18 and TNF levels in two time-point GEE models (53–723, p = 0.023 and 0.3–64, p = 0.048, respectively). IL-18BP displayed independent negative association with rapid shallow breathing index (RSBI) (95% CI: −17.6 to −4, p = 0.002). Conclusion: Sustained increased levels of IL-18 and IL-18BP, acknowledged markers of sepsis, were found to be indicative of SBT failure in patients recovering from sepsis. Our results show that, although subclinical, remaining septic inflammation that sustaines for a long time complicates the weaning procedure. Biomarkers for the estimation of the septic burden and the right time for weaning are needed.

scholarly journals Product of driving pressure and respiratory rate for predicting weaning outcomes

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110100
Author(s):  
Ju Gong ◽  
Bibo Zhang ◽  
Xiaowen Huang ◽  
Bin Li ◽  
Jian Huang
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Rate ◽  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Plateau Pressure ◽  
Driving Pressure ◽  
Failure Group ◽  
Rapid Shallow Breathing Index ◽  
Weaning Failure ◽  
Shallow Breathing

Objective Clinicians cannot precisely determine the time for withdrawal of ventilation. We aimed to evaluate the performance of driving pressure (DP)×respiratory rate (RR) to predict the outcome of weaning. Methods Plateau pressure (Pplat) and total positive end-expiratory pressure (PEEPtot) were measured during mechanical ventilation with brief deep sedation and on volume-controlled mechanical ventilation with a tidal volume of 6 mL/kg and a PEEP of 0 cmH2O. Pplat and PEEPtot were measured by patients holding their breath for 2 s after inhalation and exhalation, respectively. DP was determined as Pplat minus PEEPtot. The rapid shallow breathing index was measured from the ventilator. The highest RR was recorded within 3 minutes during a spontaneous breathing trial. Patients who tolerated a spontaneous breathing trial for 1 hour were extubated. Results Among the 105 patients studied, 44 failed weaning. During ventilation withdrawal, DP×RR was 136.7±35.2 cmH2O breaths/minute in the success group and 230.2±52.2 cmH2O breaths/minute in the failure group. A DP×RR index >170.8 cmH2O breaths/minute had a sensitivity of 93.2% and specificity of 88.5% to predict failure of weaning. Conclusions Measurement of DP×RR during withdrawal of ventilation may help predict the weaning outcome. A high DP×RR increases the likelihood of weaning failure. Statement: This manuscript was previously posted as a preprint on Research Square with the following link: https://www.researchsquare.com/article/rs-15065/v3 and DOI: 10.21203/rs.2.24506/v3

scholarly journals Ventilator induced Diaphragmatic Dysfunction assessed by Ultrasonography and its impact on Weaning outcome

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H M A Fawzy ◽  
M H M Hassan ◽  
A A M Alkholy
Keyword(s):  
Mechanical Ventilation ◽  
Operating Characteristics ◽  
Diaphragmatic Dysfunction ◽  
Rapid Shallow Breathing Index ◽  
Weaning Failure ◽  
Significant Difference ◽  
Shallow Breathing ◽  
Ventilation Modes ◽  
Weaning Outcome ◽  
Rapid Shallow Breathing

Abstract Background Ventilator induced diaphragmatic dysfunction (VIDD), as a loss of diaphragmatic force generating capacity due to the use of mechanical ventilation. Difficulties in discontinuing ventilatory support are encountered in 20–25% of mechanically ventilated patients, with a staggering 40% of time spent in the intensive care unit being devoted to weaning. M-mode ultrasonography is now an accepted qualitative method of assessing diaphragmatic motion in normal and pathological conditions. In this study, we evaluated whether diaphragmatic excursion (DE) as measured by M-mode sonography can be a predictor of weaning and diagnosis of VIDD. Aim The aim of this study is to determine the presence of ventilator induced diaphragmatic dysfunction (VIDD) diagnosed by M-mode ultrasonography and its impact on weaning outcome. Methodology This study was conducted prospectively in critical care unit in Ain Shams Hospital, a university-affiliated, tertiary referral center in Cairo, Egypt. Study subjects included 78 patients between August 2017 to August 2018. who required mechanical ventilation ≥72hrs. who fulfilled the spontaneous breath trial (SBT) criteria, at the start of a 1-hr SBT, each hemidiaphragm was evaluated M-mode sonography with the patient in the supine position. Rapid shallow Breathing index (RSBI) was simultaneously calculated at the bedside. Ultrasonographic Diaphragmatic Dysfunction (DD) was diagnosed if an Diaphragmatic Excursion (DE) was &lt;10 mm or negative, the latter indicating paradoxical diaphragmatic movement. Results Diaphragmatic Dysfunction (DD) among the eligible 78 patients was 48% (n = 37). DD group had longer weaning time [39,2 (26-56) hrs. vs. 22.3 (30-16) hrs. p = 0.001) in DD vs. NDD group respectively and total ventilation time [140 (130-150) hrs. vs. 130 (120–140) hrs. p &gt; 0.05) in DD vs. NDD group respectively. Weaning failure was (45.8% vs. 30.8%, p=0.01) in DD vs. NDD group respectively. In NDD group Rt. DE, mean 25.4 ±4.1 mm. While Lt. side was 25.3±4.6 mm, 11.25mm and 22mm (45-15) respectively. In DD group Rt. DE, mean 7.6 ±2.02mm, IQR 2.4 mm and median 8.2mm (10-1.9). While Lt. side was 9.2±0.8mm, 4.3mm and 8.9mm (9.8-5.7) respectively. The area under the receiver operating characteristics curve (ROC) of ultrasonographic criteria in predicting weaning failure was near similar to that of rapid shallow breathing index. Hypercapenic acidosis in NDD group might protect them from VIDD Conclusions DD is present in a significant percentage 48% (nearly half) of our medical ICU patients on MV ≥ 72 hrs which largely account for weaning failure. DD was associated with a significant longer weaning time, and ICU stay, with no significant difference in 30 day mortality Recommendations DE by US measurements is a valuable tool and is recommended as an adjunctive weaning index to aid prediction of weaning outcome. Evaluating the role of spontaneous ventilation modes and advanced ventilation modes as PAV and NAVA effects on decreas ing VIDD versus controlled modes.

scholarly journals Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index

Critical Care ◽  
2016 ◽  
Vol 20 (1) ◽  
Author(s):  
Savino Spadaro ◽  
Salvatore Grasso ◽  
Tommaso Mauri ◽  
Francesca Dalla Corte ◽  
Valentina Alvisi ◽  
...  
Keyword(s):  
T Tube ◽  
Rapid Shallow Breathing Index ◽  
Weaning Failure ◽  
Shallow Breathing ◽  
Rapid Shallow Breathing

scholarly journals Validation of rapid shallow breathing index displayed by the ventilator compared to the standard technique in patients with readiness for weaning

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nuttapol Rittayamai ◽  
Natwipha Ratchaneewong ◽  
Pirat Tanomsina ◽  
Withoon Kongla
Keyword(s):  
Correlation Coefficient ◽  
Spontaneous Breathing Trial ◽  
Measurement Techniques ◽  
Intraclass Correlation ◽  
Standard Technique ◽  
Time Points ◽  
Average Value ◽  
Rapid Shallow Breathing Index ◽  
Shallow Breathing ◽  
Rapid Shallow Breathing

Abstract Background Rapid shallow breathing index (RSBI) is the most commonly used parameter for predicting weaning outcome. Measurement of RSBI by Wright spirometer (RSBIstandard) is the standard method in routine clinical practice. Data specific to the accuracy and reliability of the RSBI value displayed by the ventilator (RSBIvent) are scarce. Accordingly, this study aimed to evaluate the association between the average value of RSBIvent at different time points and RSBIstandard, and to assess the accuracy and reliability of these two RSBI measurement techniques. Methods This prospective cohort study included mechanically ventilated patients who were ready to wean. At the beginning of spontaneous breathing trial using the flow-by method, RSBI was measured by two different techniques at the same time, including: (1) Wright spirometer (breathing frequency/average tidal volume in 1 min) (RSBIstandard), and (2) the values displayed on the ventilator at 0, 15, 30, 45, and 60 s (RSBIvent). Results Forty-seven patients were enrolled. The RSBIvent value was significantly higher than the RSBIstandard value for every comparison. According to Spearman’s correlation coefficient (r) and intraclass correlation coefficient (ICC), the average value of RSBI from 5 time points (0, 15, 30, 45, and 60 s) showed the best correlation with the standard technique (r = 0.76 [P < 0.001], and ICC = 0.79 [95% CI 0.61–0.88], respectively). Bland–Altman plot also showed the best agreement between RSBIstandard and the RSBIvent value averaged among 5 time points (mean difference − 17.1 breaths/min/L). Conclusions We found that the ventilator significantly overestimates the RSBI value compared to the standard technique by Wright spirometer. The average RSBIvent value among 5 time points (0, 15, 30, 45, and 60 s) was found to best correlate with RSBIstandard.

scholarly journals Influence of lung aeration on diaphragmatic contractility during a spontaneous breathing trial: an ultrasound study

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Jing Xia ◽  
Chuan-Yun Qian ◽  
Li Yang ◽  
Mei-Ju Li ◽  
Xiao-Xue Liu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Quiet Breathing ◽  
Diaphragmatic Function ◽  
Lung Aeration ◽  
Ultrasound Study ◽  
Weaning Failure ◽  
Successful Weaning ◽  
The Right

Abstract Background A spontaneous breathing trial (SBT) is a major diagnostic tool to predict successfully extubation in patients. Several factors may lead to weaning failure, including the degree of lung aeration loss and diaphragm dysfunction. The main objective was to compare the diaphragmatic contractility between patients with high lung aeration loss and low lung aeration loss during a 30-minute SBT by ultrasound. Methods This was a prospective single-center study. Lung ultrasound aeration score (LUS) and diaphragmatic thickening fraction (DTF) were measured during mechanical ventilation 1 h before SBT (T-1), 30 min (T1), and 120 min (T2) after the start of the SBT during quiet breathing. The right and left DTF were compared between patients with LUS ≥ 14 (high lung aeration loss), considered at high risk of post-extubation distress, and those with LUS < 14 (low lung aeration loss). The relationship between the LUS and DTF and the changes in LUS and DTF from T-1 to T2 in patients with LUS ≥ 14 were assessed. Results Forty-nine patients were analyzed; 33 had LUS ≥ 14 and 16 had LUS < 14 at T1. The DTF at T1 was significantly higher in patients with LUS ≥ 14 than in those with LUS < 14: the right median (IQR) DTF was 22.2% (17.1 to 30.9%) vs. 14.8% (10.2 to 27.0%) (p = 0.035), and the left median (IQR) DTF was 25.0% (18.4 to 35.0%) vs. 18.6% (9.7 to 24.2%) (p = 0.017), respectively. There was a moderate positive correlation between the LUS and the DTF (Rho = 0.3, p = 0.014). A significant increase in the LUS was observed from T-1 to T1, whereas no change was found between T1 and T2. The DTF remained stable from T-1 to T2. Conclusions During a SBT, diaphragmatic contraction acts differently depending on the degree of pulmonary aeration. In patients with high lung aeration loss, increased diaphragmatic contractility indicates an additional respiratory effort to compensate lung volume loss that would contribute to successful SBT. Further studies are needed to evaluate the combined evaluation of lung aeration and diaphragmatic function to predict the successful weaning of patients from mechanical ventilation.

scholarly journals Handgrip strength cutoff value predicting successful extubation in mechanically ventilated patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258971
Author(s):  
Narongkorn Saiphoklang ◽  
Nattawadee Mokkongphai
Keyword(s):  
Prospective Study ◽  
Roc Curve ◽  
Handgrip Strength ◽  
Spontaneous Breathing Trial ◽  
Predictive Tool ◽  
Cutoff Value ◽  
Rapid Shallow Breathing Index ◽  
Weaning Failure ◽  
A Prospective Study ◽  
Successful Extubation

Background Handgrip strength (HGS) is an alternative tool to evaluate respiratory muscle function. HGS cutoff value indicating extubation success or failure has not been investigated. This study aimed to determine HGS cutoff value to predict successful extubation. Methods A prospective study was conducted. Patients requiring intubated mechanical ventilation with intubation ≥ 48 hours in medical wards were recruited. HGS test was performed at 10 minutes before and 30 minutes after spontaneous breathing trial (SBT). Rapid shallow breathing index (RSBI) was measured at 10 minutes before SBT. Results Ninety-three patients (58% men) were included. Mean age was 71.6 ± 15.2 years. Weaning failure rate was 6.5%. The area under the ROC curve of 0.84 for the best HGS cutoff value at 10 minutes before SBT was 12.7 kg, with 75.9% sensitivity and 83.3% specificity (P = 0.005). The best HSG cutoff value at 30 minutes after SBT was 14.9 kg, with the area under the ROC curve of 0.82, with 58.6% sensitivity and 83.3% specificity (P = 0.009). The best RSBI cutoff value was 43.5 breaths/min/L, with the area under the ROC curve of 0.46, 33.3% sensitivity and 66.6% specificity (P = 0.737). Conclusions HGS may be a predictive tool to guide extubation with better sensitivity and specificity than RSBI. A prospective study is needed to verify HGS test as adjunctive to RSBI in ventilator weaning protocol.

Predictive value of diaphragmatic rapid shallow breathing index in mechanical ventilation weaning: a systematic review and meta-analysis

2020 ◽  
Keyword(s):  
Mechanical Ventilation ◽  
Predictive Value ◽  
Cochrane Library ◽  
Ultrasound Technique ◽  
Rapid Shallow Breathing Index ◽  
Weaning Failure ◽  
Ventilation Weaning ◽  
Shallow Breathing ◽  
Mechanical Ventilation Weaning ◽  
Rapid Shallow Breathing

Background: Mechanical ventilation weaning is a multifactorial process. D-RSBI cannot only reflect the respiratory function but also the diaphragmatic function with the bedside ultrasound technique. Objective: This review aimed to assess the predictive value of diaphragmatic rapid shallow breathing index (D-RSBI) of weaning outcome. Method: Databases were systematically reviewed including PubMed, Cochrane Library, Embase, CNKI and WanFang Data. Sensitivity and specificity were pooled with random effects models. Results: Nine studies met the inclusion criteria and 568 patients were involved. D-RSBI had a pooled sensitivity of 0.84 and a pooled specificity of 0.87 which predicted weaning success. D-RSBI in the success group was significantly lower than the weaning failure group. Conclusion: D-RSBI is a sensitive and specific predictor for weaning outcomes in spite of the limitations and heterogeneity among the studies. Further studies focusing on particular disease are needed as well.

Use of Ultrasound to Determine Changes in Diaphragm Mechanics During A Spontaneous Breathing Trial

2020 ◽  
pp. 088506662094316
Author(s):  
Stephen Whebell ◽  
Sunil Sane ◽  
Sumant Naidu ◽  
Hayden White
Keyword(s):  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Published Data ◽  
Diaphragmatic Dysfunction ◽  
Contraction Speed ◽  
Rapid Shallow Breathing Index ◽  
Shallow Breathing ◽  
Significant Change ◽  
Rapid Shallow Breathing ◽  
Over Time

Objective: Assess change in ultrasound measures of diaphragm mechanics over the course of a 30-minute spontaneous breathing trial (SBT). Design: Prospective observational study. Setting: Single intensive care unit (Logan Hospital, Queensland, Australia), patients recruited from August 2016 to April 2018. Participants: Eligible patients were over the age of 18 years, ventilated for >24 hours, and planned to undergo an SBT. In total, 129 patients were screened. Main outcome measures: Ultrasound measures taken at 5 and 30 minutes during SBT: diaphragmatic excursion (DE), diaphragmatic thickening fraction (DTF), and diaphragmatic contraction speed (DCS). Diaphragmatic rapid shallow breathing index (DRSBI) was calculated using DE/respiratory rate. The presence of diaphragmatic dysfunction (DD) was also determined using DTF < 30%, DE < 11 mm, or DRSBI > 1.6. Results: Eighteen patients had ultrasound measures during an SBT. Four were unable to have DTF visualized. There was no significant change in DTF (n = 14, 32.41 ± 32.21 vs 23.19 ± 17.42, P = .33) or DE (n = 18, 1.72 ± 0.63 vs 1.66 ± 0.59, P = .63) over time. Diaphragmatic contraction speed increased over time (n = 18, 2.21 ± 1.25 vs 2.67 ± 1.61, P = .007). Diaphragmatic rapid shallow breathing index worsened over time (n = 18, 1.65 ± 1.02 vs 2.08 ± 1.51, P = .03). There was no significant change in the presence of DD. Diaphragmatic dysfunction by DTF 8/14 versus 10/14, by DE 4/18 versus 3/18, and by DRSBI 7/18 versus 9/18. No patients failed SBT and one patient failed extubation. Conclusions: Diaphragmatic mechanics may change over the course of an SBT. Further research is required to determine the clinical implications of these changes and the optimal timing of diaphragmatic ultrasound to predict weaning outcome. Diaphragmatic ultrasound may be less feasible than the published data suggest.

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