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 RESEARCH ARTICLE
Year : 2017  |  Volume : 21  |  Issue : 8  |  Page : 488--493

Studying the power of the integrative weaning index in predicting the success rate of the spontaneous breathing trial in patients under mechanical ventilation


1 School of Nursing, Golestan University of Medical Sciences, Gorgan, Iran
2 Department of Anesthesiology, Cardiac Anesthesia Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
3 Department of Health and Social Medicine, Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran
4 Nursing Research Center, Nursing and Midwifery School, Golestan University of Medical Sciences, Gorgan, Iran

Correspondence Address:
Homeira Khoddam
Nursing Research Center, Nursing and Midwifery School, Golestan University of Medical Sciences, Gorgan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijccm.IJCCM_10_17

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Background and Aims: The use of weaning predictive indicators can avoid early extubation and wrongful prolonged mechanical ventilation. This study aimed to determine the power of the integrative weaning index (IWI) in predicting the success rate of the spontaneous breathing trial (SBT) in patients under mechanical ventilation. Materials and Methods: In this prospective study, 105 patients undergoing mechanical ventilation for over 48 h were enrolled. Before weaning initiation, the IWI was calculated and based on the defined cutoff point (≥25), the success rate of the SBT was predicted. In case of weaning from the device, 2-h SBT was performed and the physiologic and respiratory indices were continuously studied while being intubated. If they were in the normal range besides the patient's tolerance, the test was considered as a success. The result was then compared with the IWI and further analyzed. Results: The SBT was successful in 90 (85.7%) and unsuccessful in 15 (14.3%) cases. The difference between the true patient outcome after SBT, and the IWI prediction was 0.143 according to the Kappa agreement coefficient (P < 0.001). Moreover, regarding the predictive power, IWI had high sensitivity (95.6%), specificity (40%), positive and negative predictive values (90.5% and 60), positive and negative likelihood ratios (1.59 and 0.11), and accuracy (86.7%). Conclusion: The IWI as a more objective indicator has acceptable accuracy and power for predicting the 2-h SBT result. Therefore, in addition to the reliable prediction of the final weaning outcome, it has favorable power to predict if the patient is ready to breathe spontaneously as the first step to weaning.






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