Citation Information :
Ebrahimabadi S, Moghadam A, Vakili M. Studying the power of the integrative weaning index in predicting the success rate of the spontaneous breathing trial in patients under mechanical ventilation. Indian J Crit Care Med 2017; 21 (8):488-493.
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.
Soran A, Chelluri L, Lee KK, Tisherman SA. Outcome and quality of life of patients with acute pancreatitis requiring intensive care. J Surg Res 2000;91:89-94.
Monaco F, Drummond GB, Ramsay P, Servillo G, Walsh TS. Do simple ventilation and gas exchange measurements predict early successful weaning from respiratory support in unselected general intensive care patients? Br J Anaesth 2010;105:326-33.
Madani SJ, Saghafinia M, Nezhad HS, Ebadi A, Ghochani A, Tavasoli AF, et al. Validity of integrative weaning index of discontinuation from mechanical ventilation in Iranian ICUs. Thrita 2013;2:62-8.
Tobin MJ. Advances in mechanical ventilation. N Engl J Med 2001;344:1986-96.
MacIntyre N. Ventilator discontinuation process: Evidence and guidelines. Crit Care Med 2008;36:329-30.
MacIntyre N. Discontinuing mechanical ventilatory support. Chest 2007;132:1049-56.
Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Peñuelas O, Abraira V, et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 2013;188:220-30.
Epstein SK. Decision to extubate. Intensive Care Med 2002;28:535-46.
Epstein SK. Extubation failure: An outcome to be avoided. Crit Care 2004;8:310-2.
Nemer SN, Barbas CS, Caldeira JB, Cárias TC, Santos RG, Almeida LC, et al. A new integrative weaning index of discontinuation from mechanical ventilation. Crit Care 2009;13:R152.
Eskandar N, Apostolakos MJ. Weaning from mechanical ventilation. Crit Care Clin 2007;23:263-74, x.
Esteban A, Alía I, Tobin MJ, Gil A, Gordo F, Vallverdú I, et al. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish lung failure collaborative group. Am J Respir Crit Care Med 1999;159:512-8.
Nemer SN, Barbas CS. Predictive parameters for weaning from mechanical ventilation. J Bras Pneumol 2011;37:669-79.
El-Baradey GF, El-Shmaa NS, Ganna SA. Can integrative weaning index be a routine predictor for weaning success? Indian J Crit Care Med 2015;19:703-7.
Boniatti VM, Boniatti MM, Andrade CF, Zigiotto CC, Kaminski P, Gomes SP, et al. The modified integrative weaning index as a predictor of extubation failure. Respir Care 2014;59:1042-7.
Nezhad HS, Davood S, Jalal S. Comparison of the outcomes of weaning with currrent and IWI-based methods in patients admitted to ICU of selected hospitals in Tehran. Iranian Journal of Anaesthesiology and Critical Care 2013;3:17.
Zhou XH, McClish DK, Obuchowski NA. Statistical Methods in Diagnostic Medicine. Hoboken, New Jersey: John Wiley & Sons; 2009.
Chaiwat O, Sarima N, Niyompanitpattana K, Komoltri C, Udomphorn Y, Kongsayreepong S, et al. Protocol-directed vs. physician-directed weaning from ventilator in intra-abdominal surgical patients. J Med Assoc Thai 2010;93:930-6.
Blackwood B, Wilson-Barnett J, Patterson CC, Trinder TJ, Lavery GG. An evaluation of protocolised weaning on the duration of mechanical ventilation. Anaesthesia 2006;61:1079-86.
Girard TD, Ely EW. Protocol-driven ventilator weaning: Reviewing the evidence. Clin Chest Med 2008;29:241-52, v.
Kirakli C, Ediboglu O, Naz I, Cimen P, Tatar D. Effectiveness and safety of a protocolized mechanical ventilation and weaning strategy of COPD patients by respiratory therapists. J Thorac Dis 2014;6:1180-6.