1. Mechanical power normalized to lung-thorax compliance indicates weaning readiness in prolonged ventilated patients.
- Author
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Ghiani A, Paderewska J, Walcher S, Tsitouras K, Neurohr C, and Kneidinger N
- Subjects
- Aged, Female, Humans, Lung Compliance, Male, Middle Aged, Prospective Studies, ROC Curve, Respiration, Tracheostomy, Lung physiopathology, Thorax physiopathology, Ventilator Weaning
- Abstract
Since critical respiratory muscle workload is a significant determinant of weaning failure, applied mechanical power (MP) during artificial ventilation may serve for readiness testing before proceeding on a spontaneous breathing trial (SBT). Secondary analysis of a prospective, observational study in 130 prolonged ventilated, tracheotomized patients. Calculated MP's predictive SBT outcome performance was determined using the area under receiver operating characteristic curve (AUROC), measures derived from k-fold cross-validation (likelihood ratios, Matthew's correlation coefficient [MCC]), and a multivariable binary logistic regression model. Thirty (23.1%) patients failed the SBT, with absolute MP presenting poor discriminatory ability (MCC 0.26; AUROC 0.68, 95%CI [0.59‒0.75], p = 0.002), considerably improved when normalized to lung-thorax compliance (LTC
dyn -MP, MCC 0.37; AUROC 0.76, 95%CI [0.68‒0.83], p < 0.001) and mechanical ventilation Pa CO2 (so-called power index of the respiratory system [PIrs ]: MCC 0.42; AUROC 0.81 [0.73‒0.87], p < 0.001). In the logistic regression analysis, PIrs (OR 1.48 per 1000 cmH2 O2 /min, 95%CI [1.24‒1.76], p < 0.001) and its components LTCdyn -MP (1.25 per 1000 cmH2 O2 /min, [1.06‒1.46], p < 0.001) and mechanical ventilation Pa CO2 (1.17 [1.06‒1.28], p < 0.001) were independently related to SBT failure. MP normalized to respiratory system compliance may help identify prolonged mechanically ventilated patients ready for spontaneous breathing., (© 2022. The Author(s).)- Published
- 2022
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