HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Cohen, J. D. Articles by Singer, P. Search for Related Content PubMed PubMed Citation Articles by Cohen, J. D. Articles by Singer, P.

Automatic Tube Compensation-Assisted Respiratory Rate to Tidal Volume Ratio Improves the Prediction of Weaning Outcome^*

^* From the Department of General Intensive Care, Rabin Medical Center, Beilinson Campus, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Correspondence to: Jonathan D. Cohen, FCP(SA), Department of General Intensive Care, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel; e-mail: cohenjon{at}post.tau.ac.il

Objective: To assess whether the respiratory rate to tidal volume ratio (RVR) measured while receiving automatic tube compensation (ATC) [RVRATC] would have a better predictive value as a weaning measure than unassisted RVR.

Design: Prospective cohort study.

Setting: General ICU of a tertiary-care university hospital.

Patients: Forty-three patients who received mechanical ventilation for > 24 h and were considered ready for weaning.

Interventions: All patients underwent a 60-min spontaneous breathing trial (SBT) [positive end-expiratory pressure of 5 cm H₂O; ATC, 100%]. Patients tolerating the trial (n = 35) were extubated immediately. The following parameters were measured at the onset and end of the SBT: RVR, RVRATC, peak airway pressure (Paw), airway occlusion pressure, and minute ventilation. The outcome measure was successful extubation (ability to maintain spontaneous breathing for > 48 h).

Measurements and results: Median age was 55 years (range, 25 to 88 years), median APACHE (acute physiology and chronic health evaluation) II score was 15.5 (range, 3 to 29), and median duration of mechanical ventilation prior to the SBT was 7 days (range, 1 to 40 days). Extubation was successful in 25 patients (72%). There were no significant differences in baseline characteristics between patients successfully extubated (group 1) and those requiring reintubation. On multivariate analysis, RVRATC measured at 60 min (RVR₆₀ATC) was most predictive of successful extubation (p = 0.03). The area under the receiver operator characteristic curve was also highest for RVR₆₀ATC (0.81 ± 0.03) as compared to RVR (0.77 ± 0.03), RVRATC (0.75 ± 0.04), and RVR measured at 60 min (0.69 ± 0.05). The ratio of RVR₆₀ATC to Paw was the best predictor (0.84 ± 0.02).

Conclusions: RVRATC measured at the end of the SBT was the best predictor of successful extubation. A new ratio (ratio of RVRATC to Paw) was most predictive and deserves further study.

Key Words: automatic tube compensation • mechanical ventilation • weaning • respiratory rate to tidal volume ratio

This article has been cited by other articles:

				A. H. Petter, R. L. Chiolero, T. Cassina, P.-G. Chassot, X. M. Muller, and J.-P. Revelly Automatic "Respirator/Weaning" with Adaptive Support Ventilation: The Effect on Duration of Endotracheal Intubation and Patient Management Anesth. Analg., December 1, 2003; 97(6): 1743 - 1750. [Abstract] [Full Text] [PDF]