Comparison of the outcomes of weaning with currr ent and IWI-based methods in patients admitted to ICU of selected hospitals in Tehran

Title (persian) :

مقايسه پيامدهاي جداسازي از تهويه مكانيكي با دو روش جاري و استفاده از اندكس IWI در بيماران بستري در بخش مراقبت هاي ويژه بيمارستان هاي منتخب شهر تهران

Author(s):
Homeira Sedighi Nezhad , Seyed Davood Tadrissi , Abbas Ebadi , Seyed Jalal Madani*

Paper language: Persian

Abstract:
Introduction: Determining the patient’s readiness for weaning from mechanical ventilation and predicting the weaning outcomes are important issues that should be carefully evaluated and the risks of delay in weaning and increased mortality rates should be avoided. The aim of this study was to compare the outcomes of weaning with current and IWIbased methods in patients admitted to the intensive care units.

Materials and methods: This was a prospective clinical trial – one blind – multicenter study where 124 adult patients, who were mechanically ventilated for more than 24 hours, were evaluated in 2 groups of current and IWI-based methods (62 in each group). Initially, in current method, the rates of successful and unsuccessful weaning were evaluated in 62 patients and the threshold value of IWI was determined. In this group, the readiness for weaning and the decision to return to mechanical ventilation was made by physician in charge (who was completely blind to the result of the indexes evaluated). Then, after training the IWI to the medical team responsible for weaning, in 62 patients of the second group, weaning was made based on this index and the rates of successful and unsuccessful weaning were assessed. Ultimately, the rate of successful and failure weaning of the two groups was compared.

Conclusion: In Current method among 62 patients studied, 35 were successful and 27 unsuccessful. APACHE II in successful group was 15.09±5.68, in unsuccessful group 18.70±5.39, Carrico index (PaO2 / FiO2) in successful group was 214.102±40.35, in unsuccessful group 182.87±76.22, DO index (dissolved oxygen (SaO2)) in successful group was 96.74±2.46, in unsuccessful group 95.37±3.28, GCS Score in successful group was 9.57± 1.22, in unsuccessful group 9.30±1.54, duration of mechanical ventilation (hour) in successful group was 82.54±72.31, in unsuccessful group 89.74±82.30, IWI in successful group was 42.30±12.16, in unsuccessful group 28.24±10.70. In IWI method among 62 patients studied, 58 were successful and 4 unsuccessful. APACHE II in successful group was 13.47±4.97, in unsuccessful group 13.25±4.57, Carrico index (PaO2/FiO2) in successful group was 212.80±42.15, in unsuccessful group 176.87±14.04, DO index(dissolved oxygen(SaO2)) in successful group was 95.30±3.12, in unsuccessful group 94.25±3.86, GCS Score in successful group was 9.03±1.75, in unsuccessful group 9.25±1.50, duration of mechanical ventilation (hr) in successful group was 141.43± 63.48, in unsuccessful group 51±15.10, IWI in successful group was 65.77±26.28, in unsuccessful group 40.15± 8.13. According to the research findings and studies that examined the predictive indexes of weaning from mechanical ventilation, it is indicated that in addition to objective and subjective criteria to determine the optimal time for successful weaning, predictive indexes should be used. The use of IWI index that integrates important weaning parameters can evaluate the weaning outcome with better accuracy.

Keywords:
Integrative weaning index(=IWI), ICU, weaning outcomes, Carrico Index, RSBI

ref : magiran