Breathing pattern variability: a weaning predictor in postoperative patients recovering from systemic inflammatory response syndrome.
OBJECTIVE
To investigate whether breathing pattern variability can serve as a potential weaning predictor for postoperative patients recovering from systemic inflammatory response syndrome (SIRS).


METHODS
A prospective measurement of retrospectively analyzed breathing pattern variability in a surgical intensive care unit.


METHODS
Seventy-eight mechanically ventilated SIRS patients who had undergone abdominal surgery were included when they were ready for weaning. They were divided into success (n=57) and failure (n=21) groups based upon their weaning outcome.


RESULTS
Before weaning, tidal volume, total breath duration, inspiratory time, expiratory time, and peak inspiratory flow were continuously monitored for 30 min, while patients received 5 cmH2O pressure support weaning trial. After the patients successfully completed the trial, they were extubated. Successful weaning was defined as patients free from the ventilator for over 48 h, whereas a weaning failure was considered as reinstitution of mechanical ventilation within 48 h of extubation. The coefficient of variation and two values of standard deviation (SD1 and SD2; indicators of the dispersion of data points in the plot) obtained from the Poincaré plot of five respiratory parameters in the failure group were significantly lower than those in the success group. The area under the receiver operating characteristic curve of these variability indices was within the range of 0.73-0.80, indicating the accuracy of prediction.


CONCLUSIONS
Small breathing pattern variability is associated with a high incidence of weaning failure in postoperative patients recovering from SIRS, and this variability may potentially serve as a weaning predictor.
Bien
Mauo-Ying
MY
Institute of Physiology, School of Medicine, National Yang-Ming University, 11221, Taipei, Taiwan, Republic of China.|Department of Respiratory Therapy, Taipei Veterans General Hospital, 11217, Taipei, Taiwan, Republic of China.
Hseu
Shu-Shya
SS
Department of Anesthesiology, Department of Surgical Critical Care Unit, Taipei Veterans General Hospital, 11217, Taipei, Taiwan, Republic of China.
Yien
Huey-Wen
HW
Department of Anesthesiology, Department of Surgical Critical Care Unit, Taipei Veterans General Hospital, 11217, Taipei, Taiwan, Republic of China.
Kuo
Benjamin Ing-Tiau
BI
Laboratory of Epidemiology and Biostatistics, Taipei Veterans General Hospital, 11217, Taipei, Taiwan, Republic of China.
Lin
Yu-Ting
YT
Department of Anesthesiology, Department of Surgical Critical Care Unit, Taipei Veterans General Hospital, 11217, Taipei, Taiwan, Republic of China.
Wang
Jia-Horng
JH
Department of Respiratory Therapy, Taipei Veterans General Hospital, 11217, Taipei, Taiwan, Republic of China.
Kou
Yu Ru
YR
Institute of Physiology, School of Medicine, National Yang-Ming University, 11221, Taipei, Taiwan, Republic of China. yrkou@ym.edu.tw.
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000503:physiopathology* / Q000628:therapy; D015300:Ventilator Weaning