Predictive value of EndTidalCO₂, lung mechanics and other standard parameters for weaning neurological patients from mechanical ventilation

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• 作者：Hala A. Mohammad^a ; ^{hala_awatef@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Wegdan A. Ali^b ; ^{wegdan21122000@yahoo.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：ACS ; Acute cerebrovascular stroke ; ETCO2 ; End Tidal carbon dioxide ; ICU ; Intensive Care Unit ; MV ; mechanical ventilation ; WOB ; work of breathing ; Rinsp ; airway resistance during inspiration ; Vinsp ; peak inspiratory flow rate ; RSBI ; rapid shallow breathing index ; CMV ; controlled mandatory ventilation ; SBT ; spontaneous breathing trial ; PIP ; peak inspiratory pressure ; Pplat ; plateau pressure ; PEEP ; positive end expiratory pressure ; Cdyn ; dynamic compliance ; Cst ; static compliance ; MIP ; maximum insp
• 刊名：Egyptian Journal of Chest Diseases and Tuberculosis
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：65
• 期：1
• 页码：105-112
• 全文大小：546 K

文摘

Neurologic related respiratory failure from severe central nervous system dysfunction is one of the most frequent reasons for initiating mechanical ventilation. The present study aimed to determine the value of EndTidalCO₂ and lung mechanics as predictors of extubation failure in different neurological patients who were putting on mechanical ventilation.

Methods

Thirty two critically ill neurological patients were admitted to the general ICU with acute respiratory failure due to variable neurological insults including acute stroke, drug abuse, toxins, and C4 lesion. The patients were assessed for the following outcomes measures: Lung mechanics (compliance, airway resistance and MIP), ETCO₂, and the other standard weaning success indices including; PaO₂/FiO₂, pH, and rapid shallow breathing index (RSBI) (respiratory rate/tidal volume) at subsequent times: Initially on the beginning of using MV, and finally before extubation.

Results

Successfully weaned patients represented 56.2% (n = 18) of all patients included in this study. They had a significantly lower MV duration (3.75 ± 1.8 days) and had a significantly higher Glasgow Coma Scale (13.16 ± 1.29) than the failed weaning group. Logistic regression analysis showed a significant association between failure of weaning and each of age, MV duration, Glasgow Coma Scale <13(GCS), ETCO₂ ⩽21.1 and MIP >−16.

Conclusion

We concluded that measurements of RSBI, MIP (maximum inspiratory pressure), EndTidalCO₂ and dynamic compliance were more accurate predictors of extubation failure in patients with neurological insults than other standard weaning parameters.