The Weaning Index during Spontaneous Breathing Trials for Predicting Extubation Failure in Critically Ill Patients: A Bicentric Prospective Study.
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Mallat Jihad, Storme Nicolas, Askalany Mohamed, Helal Mohamed, Din Mehraj Ud, Samanta Sujay, Samanta Sukhen, Hamed Fadi, Edke Umesh, Carvalho Tiago, De Oliveira Bruno, Elkambergy Hussam, Dibu Jamil, Bayrlee Ahmad, Siddique Haamid, Haque Rehan, Aljaberi Nahla, Shoshan Samer, Munde Dnyaneshwar, Guilbart Mathieu, Dhundi Ujwal, Alhajri Noora, Babar Maryam, Belfegas Mehdi, Mandi Ayo, Khan Umar, Ahmed Ihab, Omer Tariq, Varghese Yeldho, Metzelard Mathieu, Charles Arvin, Kacherintavida Muhammed, Beyls Christophe, Aljasmi Mohammed, Abduljawad Baraa, Ismail Khaled, Mahjoub Yazine, Abou Arab Osama
Аннотация
METHODS: In this bicentric prospective study, ICU patients mechanically ventilated for at least 48 hours and who successfully tolerated a 30-minute SBT were included. EtCO2, RR, and WI were recorded at the beginning and end of the SBT. Changes in these parameters were analysed. Predictive performance for EF on day 7 was assessed, including areas under the receiver operating characteristic curves (AUCs).
RESULTS: Among the 114 patients, 23 (20.2%) experienced EF. Absolute changes (median [IQR]) of EtCO2, RR and WI were higher in failure group than success group respectively: 1.0 [-1.0-3.4] mmHg, 3 [1-5] breaths/min and 169.0 [94.0-232.0] mmHg x breaths/min versus -0.2 [-0.2-1.0] mmHg (p = 0.003), 0 [-1-1] breaths/min (p < 0.001) and -6.0 [-59.0-38.0] mmHg x breaths/min (p < 0.001). In multivariate adjusted models, increases in EtCO2, RR, and WI were independently associated with EF, respectives OR [95% CI]: 1.78 [1.30-2.44], 3.26 [1.77-6.01], and 1.03 [1.01-1.04]. ΔEtCO2 showed limited predictive ability for EF (AUC = 0.70 [95%CI: 0.61-0.78]), whereas ΔRR and ΔWI demonstrated excellent discrimination (AUC = 0.84 [95%CI: 0.76-0.90] and AUC = 0.91 [95%CI: 0.85-0.96]).
CONCLUSIONS: SBT-induced changes in RR and WI demonstrated excellent performance in predicting EF in critically ill patients. In contrast, changes in EtCO2 during the SBT provided limited predictive value.
REGISTRATION: The study was registered in the ClinicalTrials.gov registry: NCT05802745.