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Does taking endurance into account improve the prediction of weaning outcome in mechanically ventilated children?

INTRODUCTION: We conducted the present study to determine whether a combination of the mechanical ventilation weaning predictors proposed by the collective Task Force of the American College of Chest Physicians (TF) and weaning endurance indices enhance prediction of weaning success. METHOD: Conduct...

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Autores principales: Noizet, Odile, Leclerc, Francis, Sadik, Ahmed, Grandbastien, Bruno, Riou, Yvon, Dorkenoo, Aimée, Fourier, Catherine, Cremer, Robin, Leteurtre, Stephane
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2005
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1413999/
https://www.ncbi.nlm.nih.gov/pubmed/16356229
http://dx.doi.org/10.1186/cc3898
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author Noizet, Odile
Leclerc, Francis
Sadik, Ahmed
Grandbastien, Bruno
Riou, Yvon
Dorkenoo, Aimée
Fourier, Catherine
Cremer, Robin
Leteurtre, Stephane
author_facet Noizet, Odile
Leclerc, Francis
Sadik, Ahmed
Grandbastien, Bruno
Riou, Yvon
Dorkenoo, Aimée
Fourier, Catherine
Cremer, Robin
Leteurtre, Stephane
author_sort Noizet, Odile
collection PubMed
description INTRODUCTION: We conducted the present study to determine whether a combination of the mechanical ventilation weaning predictors proposed by the collective Task Force of the American College of Chest Physicians (TF) and weaning endurance indices enhance prediction of weaning success. METHOD: Conducted in a tertiary paediatric intensive care unit at a university hospital, this prospective study included 54 children receiving mechanical ventilation (≥6 hours) who underwent 57 episodes of weaning. We calculated the indices proposed by the TF (spontaneous respiratory rate, paediatric rapid shallow breathing, rapid shallow breathing occlusion pressure [ROP] and maximal inspiratory pressure during an occlusion test [Pi(max)]) and weaning endurance indices (pressure-time index, tension-time index obtained from P(0.1 )[TTI(1)] and from airway pressure [TTI(2)]) during spontaneous breathing. Performances of each TF index and combinations of them were calculated, and the best single index and combination were identified. Weaning endurance parameters (TTI(1 )and TTI(2)) were calculated and the best index was determined using a logistic regression model. Regression coefficients were estimated using the maximum likelihood ratio (LR) method. Hosmer–Lemeshow test was used to estimate goodness-of-fit of the model. An equation was constructed to predict weaning success. Finally, we calculated the performances of combinations of best TF indices and best endurance index. RESULTS: The best single TF index was ROP, the best TF combination was represented by the expression (0.66 × ROP) + (0.34 × Pi(max)), and the best endurance index was the TTI(2), although their performance was poor. The best model resulting from the combination of these indices was defined by the following expression: (0.6 × ROP) – (0.1 × Pi(max)) + (0.5 × TTI(2)). This integrated index was a good weaning predictor (P < 0.01), with a LR(+ )of 6.4 and LR(+)/LR(- )ratio of 12.5. However, at a threshold value <1.3 it was only predictive of weaning success (LR(- )= 0.5). CONCLUSION: The proposed combined index, incorporating endurance, was of modest value in predicting weaning outcome. This is the first report of the value of endurance parameters in predicting weaning success in children. Currently, clinical judgement associated with spontaneous breathing trials apparently remain superior.
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spelling pubmed-14139992006-03-28 Does taking endurance into account improve the prediction of weaning outcome in mechanically ventilated children? Noizet, Odile Leclerc, Francis Sadik, Ahmed Grandbastien, Bruno Riou, Yvon Dorkenoo, Aimée Fourier, Catherine Cremer, Robin Leteurtre, Stephane Crit Care Research INTRODUCTION: We conducted the present study to determine whether a combination of the mechanical ventilation weaning predictors proposed by the collective Task Force of the American College of Chest Physicians (TF) and weaning endurance indices enhance prediction of weaning success. METHOD: Conducted in a tertiary paediatric intensive care unit at a university hospital, this prospective study included 54 children receiving mechanical ventilation (≥6 hours) who underwent 57 episodes of weaning. We calculated the indices proposed by the TF (spontaneous respiratory rate, paediatric rapid shallow breathing, rapid shallow breathing occlusion pressure [ROP] and maximal inspiratory pressure during an occlusion test [Pi(max)]) and weaning endurance indices (pressure-time index, tension-time index obtained from P(0.1 )[TTI(1)] and from airway pressure [TTI(2)]) during spontaneous breathing. Performances of each TF index and combinations of them were calculated, and the best single index and combination were identified. Weaning endurance parameters (TTI(1 )and TTI(2)) were calculated and the best index was determined using a logistic regression model. Regression coefficients were estimated using the maximum likelihood ratio (LR) method. Hosmer–Lemeshow test was used to estimate goodness-of-fit of the model. An equation was constructed to predict weaning success. Finally, we calculated the performances of combinations of best TF indices and best endurance index. RESULTS: The best single TF index was ROP, the best TF combination was represented by the expression (0.66 × ROP) + (0.34 × Pi(max)), and the best endurance index was the TTI(2), although their performance was poor. The best model resulting from the combination of these indices was defined by the following expression: (0.6 × ROP) – (0.1 × Pi(max)) + (0.5 × TTI(2)). This integrated index was a good weaning predictor (P < 0.01), with a LR(+ )of 6.4 and LR(+)/LR(- )ratio of 12.5. However, at a threshold value <1.3 it was only predictive of weaning success (LR(- )= 0.5). CONCLUSION: The proposed combined index, incorporating endurance, was of modest value in predicting weaning outcome. This is the first report of the value of endurance parameters in predicting weaning success in children. Currently, clinical judgement associated with spontaneous breathing trials apparently remain superior. BioMed Central 2005 2005-11-16 /pmc/articles/PMC1413999/ /pubmed/16356229 http://dx.doi.org/10.1186/cc3898 Text en Copyright © 2005 Page et al.; licensee BioMed Central Ltd.
spellingShingle Research
Noizet, Odile
Leclerc, Francis
Sadik, Ahmed
Grandbastien, Bruno
Riou, Yvon
Dorkenoo, Aimée
Fourier, Catherine
Cremer, Robin
Leteurtre, Stephane
Does taking endurance into account improve the prediction of weaning outcome in mechanically ventilated children?
title Does taking endurance into account improve the prediction of weaning outcome in mechanically ventilated children?
title_full Does taking endurance into account improve the prediction of weaning outcome in mechanically ventilated children?
title_fullStr Does taking endurance into account improve the prediction of weaning outcome in mechanically ventilated children?
title_full_unstemmed Does taking endurance into account improve the prediction of weaning outcome in mechanically ventilated children?
title_short Does taking endurance into account improve the prediction of weaning outcome in mechanically ventilated children?
title_sort does taking endurance into account improve the prediction of weaning outcome in mechanically ventilated children?
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1413999/
https://www.ncbi.nlm.nih.gov/pubmed/16356229
http://dx.doi.org/10.1186/cc3898
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