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maximal inspiratory pressure and extubation

https://read.qxmd.com/read/22607984/respiratory-muscle-assessment-in-predicting-extubation-outcome-in-patients-with-stroke
#21
Antonio A M Castro, Felipe Cortopassi, Russell Sabbag, Luis Torre-Bouscoulet, Claudia Kümpel, Elías Ferreira Porto
BACKGROUND: Patients with cerebral infarction often present impaired consciousness and unsatisfactory extubation. We aimed to assess the respiratory mechanics components that might be associated with the success of extubation in stroke patients. METHODS: Twenty consecutive patients with stroke who needed mechanical ventilation support were enrolled. The maximal inspiratory pressure, gastric and the esophageal pressure (Pdi/Pdimax), minute volume, respiratory rate, static compliance, airway resistance, rapid and superficial respiration index (RSRI), inspiratory time/total respiratory cycle (Ti/Ttot), and PaO(2)/FiO(2) were measured...
August 2012: Archivos de Bronconeumología
https://read.qxmd.com/read/22494544/respiratory-muscle-assessment-in-predicting-extubation-outcome-in-patients-with-stroke
#22
Antonio A M Castro, Felipe Cortopassi, Russell Sabbag, Luis Torre-Bouscoulet, Claudia Kümpel, Elias Ferreira Porto
BACKGROUND: Patients with cerebral infarction often present impaired consciousness and unsatisfactory extubation. We aimed to assess the respiratory mechanics components that might be associated with the success of extubation in stroke patients. METHODS: Twenty consecutive patients with stroke who needed mechanical ventilation support were enrolled. The maximal inspiratory pressure, gastric and the esophageal pressure (Pdi/Pdimax), minute volume, respiratory rate, static compliance, airway resistance, rapid and superficial respiration index (RSRI), inspiratory time/total respiratory cycle (Ti/Ttot), and PaO(2)/FiO(2) were measured...
April 9, 2012: Archivos de Bronconeumología
https://read.qxmd.com/read/21958979/weaning-predictors-do-not-predict-extubation-failure-in-simple-to-wean-patients
#23
Augusto Savi, Cassiano Teixeira, Joyce Michele Silva, Luis Guilherme Borges, Priscila Alves Pereira, Kamile Borba Pinto, Fernanda Gehm, Fernanda Callefe Moreira, Ricardo Wickert, Cristiane Brenner Eilert Trevisan, Juçara Gasparetto Maccari, Roselaine Pinheiro Oliveira, Silvia Regina Rios Vieira
BACKGROUND: Predictor indexes are often included in weaning protocols and may help the intensive care unit (ICU) staff to reach expected weaning outcome in patients on mechanical ventilation. OBJECTIVE: The objective of this study is to evaluate the potential of weaning predictors during extubation. DESIGN: This is a prospective clinical study. SETTINGS: The study was conducted in 3 medical-surgical ICUs. PATIENTS: Five hundred consecutive unselected patients ventilated for more than 48 hours were included...
April 2012: Journal of Critical Care
https://read.qxmd.com/read/21762554/preventive-use-of-noninvasive-ventilation-after-extubation-a-prospective-multicenter-randomized-controlled-trial
#24
RANDOMIZED CONTROLLED TRIAL
Chien-Ling Su, Ling-Ling Chiang, Shih-Hsing Yang, Hen-I Lin, Kuo-Chen Cheng, Yuh-Chin T Huang, Chin-Pyng Wu
BACKGROUND: The effectiveness of noninvasive ventilation (NIV) after extubation in preventing post-extubation respiratory failure is still controversial. METHODS: We conducted a prospective, multicenter randomized controlled study involving patients on mechanical ventilation for > 48 hours who tolerated a 2-hour spontaneous breathing trial and were subsequently extubated. The patients were randomized to NIV or standard medical therapy. Re-intubation rate within 72 hours was the primary outcome measure...
February 2012: Respiratory Care
https://read.qxmd.com/read/21424827/daily-titration-of-neurally-adjusted-ventilatory-assist-using-the-diaphragm-electrical-activity
#25
Hadrien Rozé, Abdelghani Lafrikh, Virginie Perrier, Arnaud Germain, Antoine Dewitte, Francis Gomez, Gérard Janvier, Alexandre Ouattara
PURPOSE: To determine the feasibility of daily titration of the neurally adjusted ventilatory assist (NAVA) level in relation to the maximal diaphragmatic electrical activity (EAdi(maxSBT)) measured during a spontaneous breathing trial (SBT) during pressure support ventilation (PSV). METHODS: The study included 15 consecutive patients in whom mechanical ventilation weaning was initiated with the NAVA mode. EAdi(maxSBT) was determined daily during an SBT using PSV with 7 cmH2O of inspiratory pressure and no positive end-expiratory pressure (PEEP)...
July 2011: Intensive Care Medicine
https://read.qxmd.com/read/21037500/prediction-of-extubation-outcome-in-preterm-infants-by-composite-extubation-indices
#26
Gabriel Dimitriou, Sotirios Fouzas, Aggeliki Vervenioti, Sotirios Tzifas, Stefanos Mantagos
OBJECTIVE: To determine whether composite extubation indices can predict extubation outcome in preterm infants. DESIGN: Prospective observational study. SETTING: Level III neonatal intensive care unit. PATIENTS: Fifty-six preterm infants cared for in the neonatal intensive care unit of a tertiary teaching hospital during 2007 and 2008. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The study consisted of two parts...
November 2011: Pediatric Critical Care Medicine
https://read.qxmd.com/read/20795923/inspiratory-muscle-training-improves-maximal-inspiratory-pressure-and-may-assist-weaning-in-older-intubated-patients-a-randomised-trial
#27
RANDOMIZED CONTROLLED TRIAL
Samária Ali Cader, Rodrigo Gomes de Souza Vale, Juracy Correa Castro, Silvia Corrêa Bacelar, Cintia Biehl, Maria Celeste Vega Gomes, Walter Eduardo Cabrer, Estélio Henrique Martin Dantas
QUESTIONS: Does inspiratory muscle training improve maximal inspiratory pressure in intubated older people? Does it improve breathing pattern and time to wean from mechanical ventilation? DESIGN: Randomised trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS: 41 elderly, intubated adults who had been mechanically ventilated for at least 48 hr in an intensive care unit. INTERVENTION: The experimental group received usual care plus inspiratory muscle training using a threshold device, with an initial load of 30% of their maximal inspiratory pressure, increased by 10% (absolute) daily...
2010: Journal of Physiotherapy
https://read.qxmd.com/read/20196883/risk-factors-for-extubation-failure-in-infants-with-severe-acute-bronchiolitis
#28
Cíntia Johnston, Werther Brunow de Carvalho, Jefferson Piva, Pedro Celiny R Garcia, Marcelo Cunio Fonseca
OBJECTIVE: To evaluate demographic characteristics, mechanical-ventilation parameters, blood gas values, and ventilatory indexes as predictors of extubation failure in infants with severe acute bronchiolitis. METHODS: We conducted a prospective observational study from March 2004 to September 2005 with consecutive infants (ages 1-12 months) with severe acute bronchiolitis and considered ready to be extubated. We calculated mean airway pressure and oxygenation index...
March 2010: Respiratory Care
https://read.qxmd.com/read/19696443/tension-time-index-as-a-predictor-of-extubation-outcome-in-ventilated-children
#29
COMPARATIVE STUDY
Gopinathannair Harikumar, Yaya Egberongbe, Simon Nadel, Elizabeth Wheatley, John Moxham, Anne Greenough, Gerrard F Rafferty
RATIONALE: Indices that assess the load on the respiratory muscles, such as the tension-time index (TTI), may predict extubation outcome. OBJECTIVES: To evaluate the performance of a noninvasive assessment of TTI, the respiratory muscle tension time index (TTmus), by comparison to that of the diaphragm tension time index (TTdi) and other predictors of extubation outcome in ventilated children. METHODS: Eighty children (median [range] age 2...
November 15, 2009: American Journal of Respiratory and Critical Care Medicine
https://read.qxmd.com/read/18416851/noninvasive-mechanical-ventilation-may-be-useful-in-treating-patients-who-fail-weaning-from-invasive-mechanical-ventilation-a-randomized-clinical-trial
#30
RANDOMIZED CONTROLLED TRIAL
Cristiane E Trevisan, Silvia R Vieira
INTRODUCTION: The use of noninvasive positive-pressure mechanical ventilation (NPPV) has been investigated in several acute respiratory failure situations. Questions remain about its benefits when used in weaning patients from invasive mechanical ventilation (IMV). The objective of this study was to evaluate the use of bi-level NPPV for patients who fail weaning from IMV. METHODS: This experimental randomized clinical trial followed up patients undergoing IMV weaning, under ventilation for more than 48 hours, and who failed a spontaneous breathing T-piece trial...
2008: Critical Care: the Official Journal of the Critical Care Forum
https://read.qxmd.com/read/18297204/trend-of-maximal-inspiratory-pressure-in-mechanically-ventilated-patients-predictors
#31
Pedro Caruso, Denise Simão Carnieli, Keila Harue Kagohara, Adriana Anciães, Jacqueline Santos Segarra, Daniel Deheinzelin
INTRODUCTION: It is known that mechanical ventilation and many of its features may affect the evolution of inspiratory muscle strength during ventilation. However, this evolution has not been described, nor have its predictors been studied. In addition, a probable parallel between inspiratory and limb muscle strength evolution has not been investigated. OBJECTIVE: To describe the variation over time of maximal inspiratory pressure during mechanical ventilation and its predictors...
February 2008: Clinics
https://read.qxmd.com/read/17855814/respiratory-weakness-is-associated-with-limb-weakness-and-delayed-weaning-in-critical-illness
#32
Bernard De Jonghe, Sylvie Bastuji-Garin, Marie-Christine Durand, Isabelle Malissin, Pablo Rodrigues, Charles Cerf, Hervé Outin, Tarek Sharshar
OBJECTIVE: Although critical illness neuromyopathy might interfere with weaning from mechanical ventilation, its respiratory component has not been investigated. We designed a study to assess the level of respiratory muscle weakness emerging during the intensive care unit stay in mechanically ventilated patients and to examine the correlation between respiratory and limb muscle strength and the specific contribution of respiratory weakness to delayed weaning. DESIGN: Prospective observational study...
September 2007: Critical Care Medicine
https://read.qxmd.com/read/17546814/-multi-parameter-indices-of-weaning-from-mechanical-ventilation-in-children
#33
F Leclerc, T Lecine, Y Riou, B Grandbastien, O Noizet, A Dorkenoo, S Leteurtre, V Nève, A Sadik, R Cremer
UNLABELLED: Simple clinical markers have poor sensitivity; specificity and predictive value in both infants and adults when predicting the success of weaning from mechanical ventilation. Recently, multi-parametric indices, such as the CROP (Compliance-Respiratory Rate-Oxygenation-Pressure) and the RSB (Rapid-Shallow-Breathing) have been used in adults and subsequently in children. The aim of this study was to test the value of the pediatric CROP and RSB (CROPp, RSBp) and the accuracy of a simplified pediatric CROP (CROPpS) that does not require an arterial blood gas sample...
February 2002: Revue des Maladies Respiratoires
https://read.qxmd.com/read/16563329/use-of-the-rapiscope-vs-chest-auscultation-for-detection-of-accidental-bronchial-intubation-in-non-obese-patients-undergoing-laparoscopic-cholecystectomy
#34
RANDOMIZED CONTROLLED TRIAL
Tiberiu Ezri, Vadim Khazin, Peter Szmuk, Benjamin Medalion, Pinhas Shechter, Israel Priel, Mordechai Loberboim, Avi A Weinbroum
STUDY OBJECTIVE: Main stem bronchial intubation is not always detected by routine means and may occur more frequently during laparoscopic procedures. Tracheal tube positional changes in non-obese patients undergoing laparoscopic cholecystectomy were detected by either the Rapiscope (Cook Critical Care, Bloomington, Ind) or chest auscultation. DESIGN: Prospective, double-blind, crossover study. SETTING: University hospital. PATIENTS: Forty non-obese patients (BMI <28 kg...
March 2006: Journal of Clinical Anesthesia
https://read.qxmd.com/read/15127195/a-prospective-blinded-evaluation-of-indexes-proposed-to-predict-weaning-from-mechanical-ventilation
#35
Giorgio Conti, Luca Montini, Mariano Alberto Pennisi, Franco Cavaliere, Andrea Arcangeli, Maria Grazia Bocci, Rodolfo Proietti, Massimo Antonelli
OBJECTIVE: To conduct a blinded evaluation of the predictors of weaning from mechanical ventilation. DESIGN: A prospective clinical study. SETTING: A 23-bed general intensive care unit. PATIENTS: Ninety-three non-selected patients, ventilated for more than 48 h. METHODS: The study had two steps: at first, patients' data were used to select the cut-off value for weaning predictors (the minimal false classification)...
May 2004: Intensive Care Medicine
https://read.qxmd.com/read/12505966/the-endotracheal-tube-moves-more-often-in-obese-patients-undergoing-laparoscopy-compared-with-open-abdominal-surgery
#36
RANDOMIZED CONTROLLED TRIAL
Tiberiu Ezri, Vadim Hazin, David Warters, Peter Szmuk, Avi A Weinbroum
UNLABELLED: We compared the incidence of movements of the endotracheal tube (ETT) within the trachea in morbidly obese patients undergoing either laparoscopic or open gastroplasty. In a double-blinded, prospective, controlled study, 60 patients (body mass index, 35-60 kg/m(2)) were equally allocated to either laparoscopic LapBand gastroplasty (study group; Group 1) or open laparotomy gastroplasty (control; Group 2), both under standardized general anesthesia. Movements of the ETT were assessed with chest auscultation, peak inspiratory pressure, ETCO(2), SpO(2), and the Rapiscope at predetermined time points: after intubation (baseline values), 5 min before peritoneal inflation in Group 1 and 10 min postintubation in Group 2, at maximal abdominal inflation in Group 1 and 20 min into the procedure in Group 2, 5 min before and 5 min after changing the patient's position from neutral to 10 degrees head up and 10 degrees head down in Group 1 and 30 and 40 min into the procedure in Group 2, 2 min after abdominal deflation and table repositioning in Group 1 and at 50 min in Group 2, and just before extubation in both groups...
January 2003: Anesthesia and Analgesia
https://read.qxmd.com/read/12107682/an-evaluation-of-extubation-failure-predictors-in-mechanically-ventilated-infants-and-children
#37
J A Farias, I Alía, A Retta, F Olazarri, A Fernández, A Esteban, K Palacios, L Di Nunzio, G Fernández, A Bordón, C Berrondo, G Sheehan
OBJECTIVE: To assess the accuracy of traditional weaning indices in predicting extubation failure, and to compare their accuracy when indices are measured at the onset of a breathing trial (SBT) and at the end of the SBT before extubation. DESIGN: Prospective study. SETTING: Medical-surgical intensive care unit at a tertiary care hospital. PATIENTS: Four hundred eighteen consecutive infants and children who received mechanical ventilation for at least 48 h and were deemed ready to undergo a SBT by their primary physician...
June 2002: Intensive Care Medicine
https://read.qxmd.com/read/12102438/weaning-older-patients-from-long-term-mechanical-ventilation-a-pilot-study
#38
Carol Diane Epstein, Naglaa El-Mokadem, Joel R Peerless
BACKGROUND: As older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning from ventilatory support are needed to avoid premature extubation. OBJECTIVE: To describe temporal changes in pulmonary and systemic variables in older adults receiving long-term mechanical ventilation. METHODS: After 3 days of unsuccessful attempts at weaning from ventilatory support, 10 trauma and surgical patients more than 60 years old were monitored daily...
July 2002: American Journal of Critical Care
https://read.qxmd.com/read/11910389/a-pilot-study-to-investigate-any-relationship-between-sustained-maximal-inspiratory-pressure-and-extubation-outcome
#39
COMPARATIVE STUDY
Anne Bruton
OBJECTIVE: To establish whether any relationship exists between extubation outcome and sustained maximal inspiratory pressures (SMIP). DESIGN AND SETTING: Prospective clinical study in the 7-bed general intensive care unit of a university hospital. SUBJECTS: Twenty-seven intubated adults who were deemed ready for extubation were enrolled. MEASUREMENTS: Standard respiratory parameters and inspiratory muscle function data (ie, SMIP and peak maximal inspiratory pressures [MIP]) were recorded before extubation...
March 2002: Heart & Lung: the Journal of Critical Care
https://read.qxmd.com/read/11742961/predicting-success-in-weaning-from-mechanical-ventilation
#40
M Meade, G Guyatt, D Cook, L Griffith, T Sinuff, C Kergl, J Mancebo, A Esteban, S Epstein
We identified 65 observational studies of weaning predictors that had been reported in 70 publications. After grouping predictors with similar names but different thresholds, the following predictors met our relevance criteria: heterogeneous populations, 51; COPD patients, 21; and cardiovascular ICU patients, 45. Many variables were of no use in predicting the results of weaning. Moreover, few variables had been studied in > 50 patients or had results presented to generate estimates of predictive power. For stepwise reductions in mechanical support, the most promising predictors were a rapid shallow breathing index (RSBI) < 65 breaths/min/L (measured using the ventilator settings that were in effect at the time that the prediction was made) and a pressure time product < 275 cm H2O/L/s...
December 2001: Chest
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