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Research ArticleOriginal Research

Ventilatory Ratio Threshold for Unassisted Breathing: A Retrospective Exploratory Analysis

Athanasia Proklou, Eleftherios Papadakis, Eumorfia Kondili, Nikos Tserlikakis, Vlasios Karageorgos, Ioannis Konstantinou, Eugenia Triantafyllidou, Maria Bolaki, Dimitrios Georgopoulos and Katerina Vaporidi
Respiratory Care November 2021, 66 (11) 1699-1703; DOI: https://doi.org/10.4187/respcare.09208
Athanasia Proklou
Department of Intensive Care, University Hospital of Heraklion and University of Crete Medical School, Greece.
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Eleftherios Papadakis
Department of Intensive Care, University Hospital of Heraklion and University of Crete Medical School, Greece.
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Eumorfia Kondili
Department of Intensive Care, University Hospital of Heraklion and University of Crete Medical School, Greece.
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Nikos Tserlikakis
Department of Intensive Care, University Hospital of Heraklion and University of Crete Medical School, Greece.
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Vlasios Karageorgos
Department of Intensive Care, University Hospital of Heraklion and University of Crete Medical School, Greece.
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Ioannis Konstantinou
Department of Intensive Care, University Hospital of Heraklion and University of Crete Medical School, Greece.
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Eugenia Triantafyllidou
Department of Intensive Care, University Hospital of Heraklion and University of Crete Medical School, Greece.
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Maria Bolaki
Department of Intensive Care, University Hospital of Heraklion and University of Crete Medical School, Greece.
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Dimitrios Georgopoulos
Department of Intensive Care, University Hospital of Heraklion and University of Crete Medical School, Greece.
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Katerina Vaporidi
Department of Intensive Care, University Hospital of Heraklion and University of Crete Medical School, Greece.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: The ventilatory ratio (VR) is a simple index of ventilatory efficiency and dead space. Because increased dead space and high ventilatory demands impose a limitation to unassisted ventilation, and may predispose patients to injurious strong efforts during assisted ventilation, evaluation of the VR could provide helpful information during weaning. We hypothesize that there is a threshold of VR associated with tolerance of unassisted breathing.

METHODS: In a retrospective analysis, we included subjects ventilated in a control mode for at least 24 h, who were successfully liberated from mechanical ventilation, without use of noninvasive ventilation, and discharged alive from the ICU. We focused on the successful weaning attempts (the last, if more than one was performed) and evaluated the VR at the beginning and at the end of the assisted ventilation period.

RESULTS: We examined 2,000 medical records and included in our analysis 572 subjects (age: 68 y, R5-95 = 25–85, 68% male) with main admission diagnosis of respiratory failure (23%), sepsis (11%), brain injury (34%), and postoperative (14%). The VR at the beginning and the end of the assisted ventilation period was 1.5 (R5-95 = 1–2.1) and 1.4 (R5-95 = 1–2), respectively. The median duration of assisted ventilation in subjects with a VR ≥ 2 at the beginning of the assisted ventilation period was 3 d (R5-95 = 0–14 d), significantly longer than in those with a VR < 2, 0.5 d (R5-95 = 0–8 d, P < .001).

CONCLUSIONS: Successful liberation from assisted ventilation was associated with a VR < 2. A VR > 2 was associated with longer duration of weaning. The VR could be used as an additional tool to facilitate the decision-making process during weaning.

  • mechanical ventilation
  • dead space
  • assisted ventilation
  • weaning

Footnotes

  • Correspondence: Katerina Vaporidi MD PhD, University of Crete School of Medicine, Voutes Campus, Office 8A4, 70013, Heraklion, Crete, Greece. E-mail: vaporidi{at}uoc.gr
  • The study was performed at the intensive care unit of the University Hospital of Heraklion, Crete, Greece.

  • Drs Georgopoulos, Kondili, and Vaporidi disclose relationships with Medtronic. The other authors have no conflicts to disclose.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (11)
Respiratory Care
Vol. 66, Issue 11
1 Nov 2021
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Ventilatory Ratio Threshold for Unassisted Breathing: A Retrospective Exploratory Analysis
Athanasia Proklou, Eleftherios Papadakis, Eumorfia Kondili, Nikos Tserlikakis, Vlasios Karageorgos, Ioannis Konstantinou, Eugenia Triantafyllidou, Maria Bolaki, Dimitrios Georgopoulos, Katerina Vaporidi
Respiratory Care Nov 2021, 66 (11) 1699-1703; DOI: 10.4187/respcare.09208

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Ventilatory Ratio Threshold for Unassisted Breathing: A Retrospective Exploratory Analysis
Athanasia Proklou, Eleftherios Papadakis, Eumorfia Kondili, Nikos Tserlikakis, Vlasios Karageorgos, Ioannis Konstantinou, Eugenia Triantafyllidou, Maria Bolaki, Dimitrios Georgopoulos, Katerina Vaporidi
Respiratory Care Nov 2021, 66 (11) 1699-1703; DOI: 10.4187/respcare.09208
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Keywords

  • mechanical ventilation
  • dead space
  • assisted ventilation
  • weaning

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