[Application of multi-predictors in the ventilator weaning process].
OBJECTIVE
To evaluate the effects of rapid shallow breathing index (RSBI), airway occlusion pressure (P(0.1)) and traditional weaning predictors in the weaning process for patients undergoing prolonged mechanical ventilation.


METHODS
Having past 60-min spontaneous breathing trial and satisfied at least 8 of 10 traditional weaning predictors, 80 patients fulfilled the criteria of discontinuing ventilation and were included in the study. The coordinate capability of breath movement, the quantity of sputum, the quantity of rales in the lungs, the efficiency of coughing, respiratory rate, tidal volume, minute ventilation, compliance of the respiratory system, pulse oxygen saturation, pH value of the arterial blood, RSBI and P(0.1) were determined. According to the outcome of weaning from mechanical ventilation, patients were divided into a failure group and a success group. T test, chi-square test and Logistic regression analysis were used for statistics analysis.


RESULTS
Sixteen (20%) patients failed weaning. By univariate analysis, the average age, RSBI and P(0.1) values were significantly different between the failure and the success groups (P < 0.05). Logistic regression analysis with weaning outcome as the dependent variable, RSBI [(71 +/- 23) breaths.min(-1).L(-1), (53 +/- 13) breaths.min(-1).L(-1), OR = 1.03] and P(0.1) [(7.4 +/- 2.1) cm H2O, (3.6 +/- 1.4) cm H2O, OR = 6.87] were the only significant variables in the model. Using RSBI </= 105 breaths.min(-1).L(-1) as the threshold value for predicting successful weaning, the sensitivity, specificity and accuracy were 90%, 36% and 78% respectively. Using P(0.1) </= 4.5 cm H2O as the threshold value for predicting successful weaning, the sensitivity, specificity and accuracy were 87%, 66% and 82% respectively. The values of ten traditional predictors, as spirometric and gas exchange, showed no significant difference between the two groups.


CONCLUSIONS
In the weaning process for patients undergoing prolonged mechanical ventilation, RSBI and P(0.1) are valuable and accurate predictors. Traditional weaning predictors may be useless.
Tu
Xin
X
Intensive Care Unit, Shaoxing People's Hospital, Zhejiang 312000, China.
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D012121:Respiration, Artificial; D012129:Respiratory Function Tests / Q000379:methods; D015300:Ventilator Weaning; D012122:Ventilators, Mechanical