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Determinants of weaning success in patients with prolonged mechanical ventilation.
Crit Care. 2009 Jun 23;13(3):R97
Authors: Carlucci A, Ceriana P, Prinianakis G, Fanfulla F, Colombo R, Nava S
ABSTRACT: INTRODUCTION: Physiological determinants of weaning success and failure are usually studied in ventilator-supported patients comparing those who failed a trial of spontaneous breathing with those who tolerated such a trial and were successfully extubated. A major limitation of these studies was that the two groups may be not comparable concerning the severity of the underlying disease and the presence of comorbidities. In this physiological study we assessed the determinants of weaning success in patients acting as their own control, once they are eventually liberated from the ventilator. METHODS: In 30 stable tracheotomised ventilator-dependent patients admitted to the Weaning Center inside a Respiratory Intensive Care Unit, we recorded the breathing pattern, respiratory mechanics the inspiratory muscle function and the tension-time index of diaphragm (TTdi = Pdi/Pdimax i.e. tidal transdiaphragmatic pressure over maximal transdiaphragmatic pressure x Ti/Ttot i.e., the inspiratory time over the total breath duration) at the time of weaning failure (T0). The measurements were repeated in all the patients (T1) either during a successful weaning trial (successful weaning (SW) group = n.16) or 5 weeks later, in the case of repeated weaning failure (failed weaning (FW) group = n.14). RESULTS: Compared to T0, in FW at T1 significant differences were observed only for a reduction in spontaneous breathing frequency and in TTdi (0.21 +/- 0.122 vs 0.14 +/- 0.054, P=0.008). SW patients showed a significant increase in Pdimax (34.9+18.9 cmH20 vs 43.0+ 20.0 P=0.02) and decrease in Pdisw/Pdimax (36.0 +/- 15.8% vs 23.1 +/- 7.9%, P=0.004). CONCLUSIONS: The recovery of an inadequate inspiratory muscle force could be the major determinant of "late" weaning success, since this allows the patients to breathe far away from the diaphragm fatigue threshold.
PMID: 19549301 [PubMed - as supplied by publisher]