Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Ghiani, A; Paderewska, J; Walcher, S; Tsitouras, K; Neurohr, C; Kneidinger, N.
Mechanical power normalized to lung-thorax compliance indicates weaning readiness in prolonged ventilated patients
SCI REP-UK. 2022; 12(1): 6
Doi: 10.1038/s41598-021-03960-y
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Web of Science
PubMed
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- Co-Autor*innen der Med Uni Graz
- Kneidinger Nikolaus
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- Abstract:
- Since critical respiratory muscle workload is a significant determinant of weaning failure, applied mechanical power (MP) during artificial ventilation may serve for readiness testing before proceeding on a spontaneous breathing trial (SBT). Secondary analysis of a prospective, observational study in 130 prolonged ventilated, tracheotomized patients. Calculated MP's predictive SBT outcome performance was determined using the area under receiver operating characteristic curve (AUROC), measures derived from k-fold cross-validation (likelihood ratios, Matthew's correlation coefficient [MCC]), and a multivariable binary logistic regression model. Thirty (23.1%) patients failed the SBT, with absolute MP presenting poor discriminatory ability (MCC 0.26; AUROC 0.68, 95%CI [0.590.75], p=0.002), considerably improved when normalized to lung-thorax compliance (LTCdyn-MP, MCC 0.37; AUROC 0.76, 95%CI [0.680.83], p<0.001) and mechanical ventilation PaCO2 (so-called power index of the respiratory system [PIrs]: MCC 0.42; AUROC 0.81 [0.730.87], p<0.001). In the logistic regression analysis, PIrs (OR 1.48 per 1000 cmH(2)O(2)/min, 95%CI [1.241.76], p<0.001) and its components LTCdyn-MP (1.25 per 1000 cmH(2)O(2)/min, [1.061.46], p<0.001) and mechanical ventilation PaCO2 (1.17 [1.061.28], p<0.001) were independently related to SBT failure. MP normalized to respiratory system compliance may help identify prolonged mechanically ventilated patients ready for spontaneous breathing.