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ORIGINAL ARTICLE   Free accessfree

Minerva Anestesiologica 2019 April;85(4):384-92

DOI: 10.23736/S0375-9393.18.13108-7


lingua: Inglese

The Weaning Index combining EtCO2 and respiratory rate early identifies Spontaneous Breathing Trial failure

Jean-Luc BAUDEL 1, Vincent DUBEE 1, 2, Pierre-Yves BOELLE 2, 3, Simon BOURCIER 1, 2, 4, Guillaume LEBLANC 5, Jeremie JOFFRE 1, 2, 6, Naike BIGÉ 1, Gabriel PREDA 1, Guillaume DUMAS 1, Bertrand GUIDET 1, 2, 4, Eric MAURY 1, 2, 4, Hafid AIT-OUFELLA 1, 2, 6

1 Medical Resuscitation Service, Saint-Antoine Hospital, Paris, France; 2 Sorbonne-Pierre et Marie Curie University, Paris, France; 3 Public Health Service, Saint-Antoine Hospital, Paris, France; 4 Inserm U1135, Paris, France; 5 Department of Anesthesiology and Critical Care, Laval University, Québec, QC, Canada; 6 Inserm U970, Paris Research Cardiovascular Center, Paris, France

BACKGROUND: We aimed to evaluate the predictive value of the end-tidal CO2 (EtCO2) alone or combined with ventilation related parameters on Spontaneous Breathing Trial (SBT) outcome on mechanically ventilated patients.
METHODS: Prospective observational study in a medical Intensive Care Unit. Mechanically ventilated adult patients who met predefined criteria for weaning were included. Patients underwent a T-piece SBT for 30 minutes and the hemodynamic and respiratory clinical parameters including EtCO2 were recorded every five minutes.
RESULTS: The study included 280 patients, who were studied (age: 64±17 years, SAPS II: 44 [34-56]) during a first SBT and 76 patients during a second SBT. The Weaning Index, defined as the product of the respiratory rate and EtCO2, was a strong early predictive factor of SBT outcome; at 10 minutes, the area under the curve (AUC) was 86% ([80-90], P<0.0001) during the first SBT and 88% ([80-96], P<0.0001) during the second SBT. After 10 minutes of SBT, a Weaning Index >1100 identified patients that will not successfully complete the SBT at 30 minutes with a specificity of 98%.
CONCLUSIONS: In unselected mechanically ventilated patients, the Weaning Index is helpful to early identify patients who will fail the SBT during a first and a second trial.

KEY WORDS: Weaning; Respiration, artificial; Intensive Care Units; Outcome Assessment (Health Care)

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