title: Predicting weaning and extubation outcomes in long-term mechanically ventilated patients using the modified Burns Wean Assessment Program scores.
abstract: OBJECTIVE
  A number of clinical factors play pivotal roles in weaning and successful extubation of patients requiring long-term mechanical ventilator (LTMV) support. Many patients fail extubation even after passing weaning protocols and spontaneous breathing trials. This study aimed to assess the effectiveness of using a modified Burns Wean Assessment Program (m-BWAP) scoring instrument to predict extubation outcome in patients requiring LTMV.
  
  
  METHODS
  All patients with a diagnostic coding for respiratory failure requiring LTMV for longer than 21 days over a 5-year period in a single centre (total 527 patients) were included. Advanced practice nurses trained in the use of the m-BWAP scored the items according to standard definitions. All patients were weaned by pressure support weaning and spontaneous breathing trails. Patients were divided into successful and unsuccessful groups according to the weaning and extubation outcomes. Baseline data, traditional weaning parameters and m-BWAP of the groups were analysed. The sensitivity and specificity of m-BWAP for predicting successful extubation were calculated.
  
  
  RESULTS
  Of the 527 patients included, 145 (27.5%) had successful weaning trials. Of the 130 patients extubated, 102 (78.5%) had successful extubation. The m-BWAP score was higher in the patients with successful weaning trials and successful extubation outcome. Using a cut-off value of 60, the sensitivity and specificity of the m-BWAP to predict successful extubation were 81.4% and 82.1%, respectively. This was better than traditional weaning parameters.
  
  
  CONCLUSIONS
  The m-BWAP is a good predictor for weaning and extubation outcome in patients requiring LTMV for longer than 21 days.
authors.affiliation: Department of Internal Medicine, St Joseph's Hospital, Yunlin County, Taiwan.
authors.forename: Jung-Rern
authors.initials: JR
authors.lastname: Jiang
authors.forename: Shiao-Yu
authors.initials: SY
authors.lastname: Yen
authors.forename: Jung-Yien
authors.initials: JY
authors.lastname: Chien
authors.forename: Hsiao-Chien
authors.initials: HC
authors.lastname: Liu
authors.forename: Yi-Ling
authors.initials: YL
authors.lastname: Wu
authors.forename: Ching-Hui
authors.initials: CH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D060666:Airway Extubation / Q000706:statistics & numerical data; D002985:Clinical Protocols; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D015397:Program Evaluation; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D017211:Treatment Failure; D015300:Ventilator Weaning / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data
keywords: endotracheal extubation; mechanical ventilator weaning; respiratory failure weaning; weaning score