Evaluation of the Integrative Weaning Index for Predicting the Outcome of Spontaneous Breathing Trial in Patients with Cirrhosis on Mechanical Ventilation: A Pilot Study

OBJECTIVE: Studies on mechanical ventilation in patients with cirrhosis have focused mainly on survival, as the disease is considered to carry a poor prognosis. The process of weaning in these patients has never been studied. With improving survival, it would be ideal to study the weaning indices that could add experience in clinical management. The integrative weaning index is known to predict weaning failure, even in those who tolerate the spontaneous breathing trial. However, it has been evaluated mainly in patients with chronic obstructive pulmonary disease. Our aim is to study the integrative weaning index in predicting the outcome of the spontaneous breathing trial in patients with cirrhosis undergoing mechanical ventilation. METHODS: Adult cirrhotic patients requiring mechanical ventilation for the first time were enrolled. Twenty-seven patients were found eligible for weaning. After the decision to wean, the patients were put on pressure support mode of ventilator followed by spontaneous breathing trial using T-piece for 2 hours. RESULTS: The study population was divided into two groups: successful spontaneous breathing trial group (Group S) and unsuccessful spontaneous breathing trial group (Group U) based on the outcome of the breathing trial. The mean respiratory rate was significantly lower in Group S as compared to Group U. The compliance of the respiratory system and integrative weaning index were found to be significantly higher in Group S. An integrative weaning index of 28 mL/cmH(2)O breaths/min/L was found to be a good predictor of weaning success. CONCLUSIONS: Our results demonstrate that weaning from mechanical ventilation is possible in critically ill patients with cirrhosis. An integrative weaning index of 28 mL/cmH(2)O breaths/min/L could be a successful predictor of weaning from mechanical ventilation.