Critical Care Medicine

Adult Critical Care

Comparisons of predictive performance of breathing pattern variability measured during T-piece, automatic tube compensation, and pressure support ventilation for weaning intensive care unit patients from mechanical ventilation

Bien M-Y, Lin YS, Shih C-H, et al (Taipei Med Univ Hosp, Taiwan; et al) Crit Care Med 39:2253-2262, 2011^§

Abstract

Objective

To investigate the influence of different ventilatory supports on the predictive performance of breathing pattern variability for extubation outcomes in intensive care unit patients.

Design and Setting

A prospective measurement of retrospectively analyzed breathing pattern variability in a medical center.

Patients

Sixty-eight consecutive and ready-for-weaning patients were divided into success (n = 45) and failure (n = 23) groups based on their extubation outcomes.

Measurements

Breath-to-breath analyses of peak inspiratory flow, total breath duration, tidal volume, and rapid shallow breathing index were performed for three 30-min periods while patients randomly received T-piece, 100% inspiratory automatic tube compensation with 5 cm H₂O positive end-expiratory pressure, and 5 cm H₂O pressure support ventilation with 5 cm H₂O positive end-expiratory pressure trials. Coefficient of variations and data dispersion (standard descriptor values SD₁ and SD₂ of the Poincaré plot) were analyzed to serve as breathing pattern variability indices.

Main Results

Under all three trials, breathing pattern variability in extubation failure patients was smaller than in extubation success patients. Compared to the T-piece trial, 100% inspiratory automatic tube compensation with 5 cm H₂O positive end-expiratory pressure and 5 cm H₂O pressure support ventilation with 5 cm H₂O positive end-expiratory pressure decreased the ability of certain breathing pattern variability indices to discriminate extubation success from extubation failure. The areas under the receiver operating characteristic curve of these breathing pattern variability indices were: T-piece (0.73–0.87) > 100% inspiratory automatic tube compensation with 5 cm H₂O positive end-expiratory pressure (0.60–0.79) >5 cm H₂O pressure support ventilation with 5 cm H₂O positive end-expiratory pressure (0.53–0.76). Analysis of the classification and regression tree indicated that during the T-piece trial, a SD₁ of peak inspiratory flow >3.36 L/min defined a group including all extubation success patients. Conversely, the combination of a SD₁ of peak inspiratory flow ≤3.36 L/min and a coefficient of variations of rapid shallow breathing index ≤0.23 defined a group of all extubation failure patients. The decision strategies using SD₁ of peak inspiratory flow and coefficient of variations of rapid shallow breathing index measured during 100% inspiratory automatic tube compensation with 5 cm H₂O positive end-expiratory pressure and 5 cm H₂O pressure support ventilation with 5 cm H₂O positive end-expiratory pressure trials achieved a less clear separation of extubation failure from extubation success.

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