End-Expiratory Lung Volumes During Spontaneous Breathing Trials in Tracheostomized Subjects on Prolonged Mechanical Ventilation

2021 ◽  
pp. respcare.08957
Author(s):  
Jui-Chen Cheng ◽  
Hui-Chuan Chen ◽  
Jih-Shuin Jerng ◽  
Ping-Hung Kuo ◽  
Huey-Dong Wu
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Prolonged Mechanical Ventilation ◽  
Lung Volumes ◽  
Spontaneous Breathing Trials

scholarly journals Noninvasive ventilation during the weaning process in chronically critically ill patients

2016 ◽  
Vol 2 (4) ◽  
pp. 00061-2016 ◽  
Author(s):  
Jesus Sancho ◽  
Emilio Servera ◽  
Luis Jara-Palomares ◽  
Emilia Barrot ◽  
Raquel Sanchez-Oro-Gómez ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Noninvasive Ventilation ◽  
Critically Ill Patients ◽  
Predictive Value ◽  
Spontaneous Breathing ◽  
Prolonged Mechanical Ventilation ◽  
Respiratory Care ◽  
Spontaneous Breathing Trials ◽  
Chronically Critically Ill

Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV) during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process.We conducted a prospective study that included chronically critically ill patients admitted to Spanish respiratory care units. The weaning method used consisted of progressive periods of spontaneous breathing trials. Patients were transferred to NIV when it proved impossible to increase the duration of spontaneous breathing trials beyond 18 h.231 chronically critically ill patients were included in the study. 198 (85.71%) patients achieved weaning success (mean weaning time 25.45±16.71 days), of whom 40 (21.4%) needed NIV during the weaning process. The variable which predicted the need for NIV was arterial carbon dioxide tension at respiratory care unit admission (OR 1.08 (95% CI 1.01–1.15), p=0.013), with a cut-off point of 45.5 mmHg (sensitivity 0.76, specificity 0.67, positive predictive value 0.76, negative predictive value 0.97).NIV is a useful tool during weaning in chronically critically ill patients. Hypercapnia despite mechanical ventilation at respiratory care unit admission is the main predictor of the need for NIV during weaning.

scholarly journals THE IDEAL PROFILE (INCREASE IN B-LINES/DELTA B-LINES) ON LUNG ULTRASOUND FOR DIAGNOSING WEANING INDUCED PULMONARY EDEMA IN VENTILATED PATIENTS

2022 ◽  
Vol 71 (6) ◽  
pp. 2220-23
Author(s):  
Ghulam Rasheed ◽  
Zahid Siddique Shad ◽  
Tooba Mehreen ◽  
Nusrat Kharadi ◽  
Moazma Ramzan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Pulmonary Edema ◽  
Spontaneous Breathing ◽  
Lung Ultrasound ◽  
Weaning Failure ◽  
Before And After ◽  
Spontaneous Breathing Trials ◽  
B Lines ◽  
Ventilated Patients ◽  
The Ideal

Objective: To ascertain the ideal number of B-lines on lung ultrasound for the diagnosis of weaning induced pulmonary edema in ventilated patients. Study Design: Prospective observational study. Place and Duration of Study: Department of Medicine, Shifa International Hospital, Islamabad, from Jan to Aug 2020. Methodology: All the patients over the age of 18 years who were on mechanical ventilation in a medical intensive care unit were included in the study. The patients were given spontaneous breathing trials as a protocol for weaning from mechanical ventilation. Lung ultrasound was performed on 4 points of anterior chest wall before and after spontaneous breathing trials. Before and after spontaneous breathing trials counting of B lines was done on ultrasound of lung and comparison of increase in B lines (Delta-B-lines) was done with reference diagnosis of weaning induced pulmonary edema diagnosed by intensivist who was blinded to the results of lung ultrasound. Results: The study included 42 patients including 23 (54.8%) men and 19 (45.2%) women. 14 cases failed spontaneous breathing trials. Seven cases (16.7%) had weaning induced pulmonary edema. Delta-B-lines ≥6 diagnosed weaning induced pulmonary edema with 100% accuracy. Out of the remaining seven patients with weaning failure but without weaning induced pulmonary edema, 6 (28.6%) had Delta-B-lines ≥6. The ultrasound lung technique had a 100% sensitivity profile to detect weaning induced pulmonary edema and a specificity of 77.78%. Conclusion: The study indicates that Delta-B-lines ≥6 diagnosed the weaning induced pulmonary edema with the best accuracy.

Weaning failure in critical illness

2016 ◽  
Author(s):  
Annalisa Carlucci ◽  
Paolo Navalesi
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Respiratory Muscle ◽  
Prolonged Mechanical Ventilation ◽  
Spontaneous Breathing Trial ◽  
Extubation Failure ◽  
High Morbidity ◽  
Weaning Failure ◽  
Generating Capacity ◽  
The One

Weaning failure has been defined as failure to discontinue mechanical ventilation, as assessed by the spontaneous breathing trial, or need for re-intubation after extubation, so-called extubation failure. Both events represent major clinical and economic burdens, and are associated with high morbidity and mortality. The most important mechanism leading to discontinuation failure is an unfavourable balance between respiratory muscle capacity and the load they must face. Beyond specific diseases leading to loss of muscle force-generating capacity, other factors may impair respiratory muscle function, including prolonged mechanical ventilation, sedation, and ICU-acquired neuromuscular dysfunction, potentially consequent to multiple factors. The load depends on the mechanical properties of the respiratory system. An increased load is consequent to any condition leading to increased resistance, reduced compliance, and/or occurrence of intrinsic positive-end-expiratory pressure. Noteworthy, the load can significantly increase throughout the spontaneous breathing trial. Cardiac, cerebral, and neuropsychiatric disorders are also causes of discontinuation failure. Extubation failure may depend, on the one hand, on a deteriorated force-load balance occurring after removal of the endotracheal tube and, on the other hand, on specific problems. Careful patient evaluation, avoidance and treatment of all the potential determinants of failure are crucial to achieve successful discontinuation and extubation.

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