Chest
Clinical Investigations in Critical CarePredictors of Weaning After 6 Weeks of Mechanical Ventilation
Section snippets
Data Collection
Data were gathered from the medical records of 421 consecutive ventilator-dependent patients (initial group) admitted over a 37-month period. Age, sex, results of routine laboratory tests on admission, and duration of mechanical ventilation prior to admission to BRH were noted. Presence and stage of decubitus ulceration were noted, as was level of consciousness on admission. The number of medications required to treat infection, bronchospasm, congestive heart failure, and arrhythmias was
Correlation With Outcome
Complete data were available in 395 of the initial 421 patient records reviewed. Eighteen patients were not included because of transfer to other acute care facilities for treatment of intercurrent surgical problems before outcome could be determined. The top portion of Table 1 displays all variables that correlated significantly with outcome in this initial patient data set. Selected variables and their correlation with outcome in the 170-patient validation group are shown in the lower part of
Clinical Information
Prediction has been widely decried as an imperfect science,9 but the clinical, economic, and ethical challenges posed by patients requiring prolonged ventilatory support generate a need for data on which to base decisions. In these patients, both duration of ventilator dependency and number of weaning attempts—the gradual withdrawal of the ventilator over usually weeks or even months, as opposed to hours to days—are different from ICU patients in whom outcome predictors have been extensively
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Cited by (48)
Predictive factors of weaning from mechanical ventilation and extubation outcome: A systematic review
2018, Journal of Critical CareCitation Excerpt :Some parameters were discussed in two articles: level of consciousness [23,35], natriuretic peptide (BNP) [48,49], partial pressure of arterial oxygen (PaO2) [19,24], and heart failure [20,23]. Specific predictors for weaning success include the CORE index [19,50] (calculated as [Cdyn x (PImax/P0.1) x (PaO2/PAO2)]/f), arterial pH [19,20], blood urea nitrogen (BUN) level [32,35], the Integrative Weaning Index (IWI) [51,52], and the Oxygen Cost of Breathing (OCOB) [37,53]. Specific predictors of extubation success include the Occlusion Pressure (PO.1) [18,34], fluid balance [22,44], chronic obstructive pulmonary disease (COPD) [22,23], and lung compliance [23,31].
Testing the prognostic value of the rapid shallow breathing index in predicting successful weaning in patients requiring prolonged mechanical ventilation
2012, Heart and Lung: Journal of Acute and Critical CareValue of the PaO<inf>2</inf>:FiO<inf>2</inf> ratio and Rapid Shallow Breathing Index in predicting successful extubation in hypoxemic respiratory failure
2010, Heart and Lung: Journal of Acute and Critical CareSuccessful weaning predictors in a respiratory care center in Taiwan
2008, Kaohsiung Journal of Medical Sciences
Presented in part at the American College of Chest Physicians Annual Scientific Assembly, Chicago, October, 1992; and at the American Lung Association/American Thoracic Society International Conference, San Francisco, May, 1993.
This study was funded by grants from the Barlow Foundation, Harold R. and Winifred R. Swanton Foundation, and the Lluella Morey Murphey Foundation.
Manuscript received revision accepted June 10.
Reprint requests: Dr. Scheinhorn, Barlow Respiratory Hospital, 2000 Stadium Way, Los Angeles, CA 90026-2696