A new integrative weaning index of discontinuation from mechanical ventilation.
BACKGROUND
Indexes predicting weaning outcome are frequently inaccurate. We developed a new integrative weaning index aimed at improving the accuracy of the traditional indexes.


METHODS
Three hundred and thirty-one patients mechanically-ventilated for more than 24 hours were evaluated. Initially, the threshold values of each index that best discriminate between a successful and an unsuccessful weaning outcome were determined in 115 patients. In the second phase, the predictive performance of these values was tested prospectively in the other 216 patients. Frequency/tidal volume ratio (f/Vt ratio), tidal volume (Vt), tracheal airway occlusion pressure 0.1 s (P 0.1), the product of P 0.1 and f/Vt (P 0.1 x f/Vt), respiratory rate (f), static compliance of the respiratory system (Cst,rs), ratio of arterial oxygen tension to fraction of inspired oxygen (PaO2/FiO2 ratio) and the new integrative weaning index IWI (Cst,rs x arterial oxygen saturation/f/Vt ratio) were evaluated in all patients. The readiness for weaning and the decision to return to mechanical ventilation was made by the physician in charge, based on the signs of poor tolerance. The receiver operating characteristic (ROC) curves were calculated in order to evaluate the predictive performance of each index. The Bayes' theorem was used to assess the probability of each test of predicting weaning.


RESULTS
In the prospective-validation set, successful weaning was observed in 183 patients (84.7%) and weaning failure in 33 (15.27%). IWI presented the highest accuracy, with the area under the ROC curves larger than that under the curves for the f/Vt ratio (0.96 x 0.85 respectively; P = 0.003), and also larger than that under the curves for the other indexes. IWI presented a higher probability of successful weaning when the test was positive (0.99) and a lower probability when the test was negative (0.14). Measurement of Cst,rs during the weaning process was considered one of the study limitations.


CONCLUSIONS
IWI was the best predictive performance index of weaning outcome and can be used in the intensive care unit setting.


BACKGROUND
controlled-trials.com ISRCTN92117906.
Nemer
Sergio N
SN
Critical Care Department, Hospital de Clínicas de Niterói, Centro, Niterói, Rio de Janeiro, CEP 24020-090, Brazil. snnemer@urbi.com.br
Barbas
Carmen S V
CS
Caldeira
Jefferson B
JB
Cárias
Thiago C
TC
Santos
Ricardo G
RG
Almeida
Luiz C
LC
Azeredo
Leandro M
LM
Noé
Rosângela A
RA
Guimarães
Bruno S
BS
Souza
Paulo C
PC
D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D015415:Biomarkers / Q000032:analysis; D004059:Diffusion of Innovation; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012143:Respiratory Physiological Phenomena; D015300:Ventilator Weaning / Q000379:methods*
D015415:Biomarkers