13. Comparing the prognostic value of the P0.1 index with other indicators in predicting weaning from mechanical ventilation

Phan Nguyen Dai Nghia, Hoang Bui Hai

Main Article Content

Abstract

This study aimed to evaluate the value of the P0.1 index and weaning indexes in weaning from mechanical ventilation in patients with pneumonia requiring intubation. All of the study parameters were taken independently of the clinicians and then processed to provide Cut-off values, sensitivity, specificity, and area under the curve. With a Cut-off value of P0.1 of -5.5 cmH2O, the sensitivity and specificity were 95.8% and 66.7%, respectively, with an area under the curve value of 0.712 (95%CI: 0.41 - 1). The P0.1 index had a moderate predictive value in weaning from mechanical ventilation in pneumonia patients requiring endotracheal tube placement. Other prognostic indicators had high sensitivities, specifically the sensitivity of minute ventilation, rapid shallow breathing index, and P/F index, which were 100%, 100%, and 98%, respectively. However, their specificities were very low, at 20.8%, 2.1%, and 0% respectively. We suggest that the P0.1 index was valuable in predicting weaning from mechanical ventilation in pneumonia patients receiving ventilation through endotracheal intubation.

Article Details

References

1. Brochard LJ, Slutsky AS. Mechanical Ventilation: State of the Art. Mayo Clin Proc. 2017;92(9):1382-1400. doi:10.1016/j.mayocp.2017.05.004
2. Martin J Tobin. Advances in Mechanical Ventilation. NEJM. 2001;344:1986-1996. doi: 10.1056/NEJM200106283442606.
3. J-M Boles, J Bion, A Connors, et al. Weaning from mechanical ventilation. European Respiratory Journal. 2007;29:1033-1056. doi: 10.1183/09031936.00010206
4. Brochard L, Thille AW. What is the proper approach to liberating the weak from mechanical ventilation? Crit Care Med. 2009;37(10):S410. doi:10.1097/CCM.0b013e3181b6e28b
5. MacIntyre NR, Cook DJ, Ely EW, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: A collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest. 2001;120(6 Suppl):375S-95S. doi:10.1378/chest.120.6_su ppl.375s
6. Nemer SN, Barbas CSV, Caldeira JB, et al. Evaluation of maximal inspiratory pressure, tracheal airway occlusion pressure, and its ratio in the weaning outcome. J Crit Care. 2009;24(3):441-446. doi:10.1016/j.jcrc.2009.0 1.007
7. Thille AW, Richard JCM, Brochard L. The decision to extubate in the intensive care unit. Am J Respir Crit Care Med. 2013;187(12):1294-1302. doi:10.1164/rccm.201208-1523CI
8. Bronagh Blackwood, Fiona Alderdice, Karen Burns, et al. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. BMJ. 2011;342. doi: https://doi.org/10.1136/bmj.c7237
9. Trần Việt Đức, Vũ Hoàng Phương, Nguyễn Thụ. Đánh giá giá trị tiên lượng cai thở máy thành công của chỉ số thở nhanh nông ở bệnh nhân hồi sức ngoại khoa. Tạp chí Nghiên cứu Y học. 2019;123(7):121-127.
10. Sassoon CS, Mahutte CK. Airway occlusion pressure and breathing pattern as predictors of weaning outcome. Am Rev Respir Dis. 1993;148(4 Pt 1):860-866. doi:10.1164/ajrccm/148.4_Pt_1.860
11. Montgomery AB, Holle RH, Neagley SR, et al. Prediction of successful ventilator weaning using airway occlusion pressure and hypercapnic challenge. Chest. 1987;91(4):496-499. doi:10.1378/chest.91.4.496
12. Conti G, Montini L, Pennisi MA, et al. A prospective, blinded evaluation of indexes proposed to predict weaning from mechanical ventilation. Intensive Care Med. 2004;30(5):830-836. doi:10.1007/s00134-004-2230-8