TY - JOUR
T1 - Automatic tube compensation-assisted respiratory rate to tidal volume ratio improves the prediction of weaning outcome
AU - Cohen, Jonathan D.
AU - Shapiro, Maury
AU - Grozovski, Elad
AU - Singer, Pierre
PY - 2002
Y1 - 2002
N2 - Objective: To assess whether the respiratory rate to tidal volume ratio (RVR) measured while receiving automatic tube compensation (ATC) [RVRATC] would have a better predictive value as a weaning measure than unassisted RVR. Design: Prospective cohort study. Setting: General ICU of a tertiary-care university hospital. Patients: Forty-three patients who received mechanical ventilation for > 24 h and were considered ready for weaning. Interventions: All patients underwent a 60-min spontaneous breathing trial (SBT) [positive end-expiratory pressure of 5 cm H2O; ATC, 100%]. Patients tolerating the trial (n = 35) were extubated immediately. The following parameters were measured at the onset and end of the SBT: RVR, RVRATC, peak airway pressure (Paw), airway occlusion pressure, and minute ventilation. The outcome measure was successful extubation (ability to maintain spontaneous breathing for > 48 h). Measurements and results: Median age was 55 years (range, 25 to 88 years), median APACHE (acute physiology and chronic health evaluation) II score was 15.5 (range, 3 to 29), and median duration of mechanical ventilation prior to the SBT was 7 days (range, 1 to 40 days). Extubation was successful in 25 patients (72%). There were no significant differences in baseline characteristics between patients successfully extubated (group 1) and those requiring reintubation. On multivariate analysis, RVRATC measured at 60 min (RVR60ATC) was most predictive of successful extubation (p = 0.03). The area under the receiver operator characteristic curve was also highest for RVR60ATC (0.81 ± 0.03) as compared to RVR (0.77 ± 0.03), RVRATC (0.75 ± 0.04), and RVR measured at 60 min (0.69 ± 0.05). The ratio of RVR60ATC to Paw was the best predictor (0.84 ± 0.02). Conclusions: RVRATC measured at the end of the SBT was the best predictor of successful extubation. A new ratio (ratio of RVRATC to Paw) was most predictive and deserves further study.
AB - Objective: To assess whether the respiratory rate to tidal volume ratio (RVR) measured while receiving automatic tube compensation (ATC) [RVRATC] would have a better predictive value as a weaning measure than unassisted RVR. Design: Prospective cohort study. Setting: General ICU of a tertiary-care university hospital. Patients: Forty-three patients who received mechanical ventilation for > 24 h and were considered ready for weaning. Interventions: All patients underwent a 60-min spontaneous breathing trial (SBT) [positive end-expiratory pressure of 5 cm H2O; ATC, 100%]. Patients tolerating the trial (n = 35) were extubated immediately. The following parameters were measured at the onset and end of the SBT: RVR, RVRATC, peak airway pressure (Paw), airway occlusion pressure, and minute ventilation. The outcome measure was successful extubation (ability to maintain spontaneous breathing for > 48 h). Measurements and results: Median age was 55 years (range, 25 to 88 years), median APACHE (acute physiology and chronic health evaluation) II score was 15.5 (range, 3 to 29), and median duration of mechanical ventilation prior to the SBT was 7 days (range, 1 to 40 days). Extubation was successful in 25 patients (72%). There were no significant differences in baseline characteristics between patients successfully extubated (group 1) and those requiring reintubation. On multivariate analysis, RVRATC measured at 60 min (RVR60ATC) was most predictive of successful extubation (p = 0.03). The area under the receiver operator characteristic curve was also highest for RVR60ATC (0.81 ± 0.03) as compared to RVR (0.77 ± 0.03), RVRATC (0.75 ± 0.04), and RVR measured at 60 min (0.69 ± 0.05). The ratio of RVR60ATC to Paw was the best predictor (0.84 ± 0.02). Conclusions: RVRATC measured at the end of the SBT was the best predictor of successful extubation. A new ratio (ratio of RVRATC to Paw) was most predictive and deserves further study.
KW - Automatic tube compensation
KW - Mechanical ventilation
KW - Respiratory rate to tidal volume ratio
KW - Weaning
UR - http://www.scopus.com/inward/record.url?scp=0036382854&partnerID=8YFLogxK
U2 - 10.1378/chest.122.3.980
DO - 10.1378/chest.122.3.980
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C2 - 12226043
AN - SCOPUS:0036382854
SN - 0012-3692
VL - 122
SP - 980
EP - 984
JO - Chest
JF - Chest
IS - 3
ER -