ORIGINAL ARTICLE   Free access

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

DOI: 10.23736/S0375-9393.18.13108-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

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)