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Purpose: Some patients with respiratory failure fail initial weaning attempts and need prolonged mechanical ventilation (MV). Prolonged MV is associated with many complications and consumption of heathcare resources. Objective weaning indices help staffs to identify high-potential patients for weaning from the MV. Traditional weaning indices are not reliable in clinical practice. Transitional percentage of minute volume (TMV%) is a new index of the work of breathing. This study aimed to investigate the utility of TMV% in the prediction of weaning potential. Methods: This study was prospectively performed including all patients with prolonged MV. Researchers recorded their demographics, TMV%, respiratory parameters, Acute Physiology and Chronic Health Evaluation II score, and laboratory data upon arrival at the respiratory care center. The factors associated with successful weaning were analyzed. Results: Out of the 120 patients included, 84 (70.0%) were successfully weaned from MV. Traditional weaning indices such as rapid shallow breathing index could not predict the weaning outcome. TMV% was a valuable parameter as patients with a lower TMV%, higher tidal volume, higher hemoglobin, lower blood urea nitrogen, and lower Acute Physiology and Chronic Health Evaluation II scores had a higher rate of successful weaning. TMV%, tidal volume, and HCO3- levels were independent predictors of successful weaning, and the area under the curve was .79 in the logistic regression model. Conclusion: TMV% is a novel and effective predictor of successful weaning. Patients with lower TMV% had a higher MV weaning outcome. Once patients with a high potential for successful weaning are identified, they should be aggressively weaned from MV as soon as possible. Clinical Trials Government Identifier: NCT033480. Keywords: respiratory insufficiency, ventilators, mechanical, work of breathing

background: Mechanical ventilation(MV) in patient with respiratory failure that can provide patient to keep adequate oxygenation and ventilation. After acute ilness, the number of patients requiring prolong MV has increased because they cannot be weaned from MV. It is poorly outcome that patients undergoing prolonged MV, and that is associated with various complications. Therefore, how to wean from MV as soon as possible is important issue. Transition MinVol% (TMV%) is an index of work breathing, and it means the transition of spontaneous breathing to mandatory breathing. Aim: We try to established a utility and accuracy weaning parameter to predicate weaning successful. Methods: This was a prospective study and included 120 adult patients between January,2017 and December,2017. All patients, using mechanical ventilator for at least 21 days and in stable hemodynamics condition, admitted to our 12-bed respiratory care center (RCC) in Taiwan. We recorded and analyzed their demographics, TMV%, respiratory parameters, APACHE II score, and laboratory data upon arrived at RCC. Results: Successful weaned from MV in 70% (84/120) of patients. Lower TMV% had higher successful weaning rate. Multivariate logistic regression analysis identified TMV%(OR=0.983, p=0.006); VT (OR=1.011, p Conclusions: TMV%, a novel respiratory parameter, is a useful predictor of weaning outcome in patients with prolonged MV.

Gorham syndrome is a rare disease that presents as progressive osteolysis, and may affect any part of the skeleton. The pathologic process involves the replacement of normal bone by aggressively expanding but non-neoplastic vascular tissue, resulting in massive osteolysis of the adjacent bone. If the spine and ribs are affected, the subsequent kyphosis and chest wall deformity may cause severe restrictive ventilatory impairment. We report a 34-year-old male with Gorham syndrome presenting as progressive kyphosis, severe back pain, unstable gait, and exertional dyspnea. Pulmonary function testing revealed severe restrictive ventilatory impairment. He underwent spinal surgery but could not be extubated after surgery. Postoperative left lower lung pneumonia and respiratory failure required prolonged mechanical ventilation. After a weaning program of pressure support ventilation and T-piece spontaneous breathing trials, he was successfully weaned from mechanical ventilation.