Validity of Integrative Weaning Index of Discontinuation From Mechanical Ventilation in Iranian ICUs

Abstract

Background: Today, usage of weaning index is a controversial issue. Proper use of these indexes is beneficial for prevention of the losses caused by weaning failure, rapid and reliable identification of patients who are potentially ready for spontaneous breathing and accelerating the weaning of mechanical ventilation.

Objectives: This study is to determine the validity of integrative weaning index as a mechanical ventilation discontinuation predictor in patients hospitalized in the Iranian intensive care units.

Patients and Methods: This scale was evaluated on 124 adult patients who were on mechanical ventilation for more than 24 hours, in two 24-hour phases, in six ICUs (Surgery-Trauma-Medical-Poisoning) of selected hospitals in Tehran, totaling 60 beds, by the researcher as a single blind test. Inclusion criteria were: Patient 18 to 80 years old, none of them suffering from neurological and neuromuscular diseases, none or a minimal dose of sedative drugs being used (15 – 18 points based on Palma and Cook criteria), non-addict or heavy smokers, not admitted in ICU-OH. The study was conducted from November 2011 to December 2012. The ventilators used were from Rafael brand.

Results: There were 80 successful and 44 unsuccessful as well as 72 successful and 8 unsuccessful weaning cases in the first and second phase of the study, respectively. The area under the ROC curves for IWI was 0.967, with standard error of 0.020, 95% Confidence interval of 0.899 to 0.993 and Significance level of P = 0.001, SE = 94.59, SP = 66.67, PPV = 97.22, NPV = 50, DA = 92.5 and likelihood ratio of positive test being 2.84 besides the lowest likelihood ratio of negative test equal to 0.08), with Diagnostic odds ratio being 97% and Confidence interval of 0.82 to 0.97.

Conclusions: Integrative weaning index has appropriate predictive validity for weaning patients from mechanical ventilation in Iranian intensive care units.

Keywords: Intensive Care Units; Respiration, Artificial; Ventilator Weaning

ref : Thrita

Download Full article : http://thritajournal.com/30257.pdf

Pulmonary infections in ICU patients without underlying disease on ventilators.

Abstract

BACKGROUND:

At present, the use of ventilator support is an important part of treatment in ICU patients. However, aside from its well-known advantages, the use of these devices is also associated with complications, the most important of which is pulmonary infection (PI). PI has a high rate of morbidity and mortality.

OBJECTIVES:

This study aimed to evaluate the prevalence of PI in mechanically-ventilated patients and the role that factors, such as age, sex, and duration of intubation, play in this regard.

MATERIALS AND METHODS:

This descriptive cross-sectional study evaluated the prevalence of PI in mechanically ventilated patients, with no underlying condition which could compromise their immune system. Age, sex, and duration of intubation were assessed. Data were analyzed using SPSS (version 16) software.

RESULTS:

A total of 37 ICU patients on ventilators were evaluated, including 21 males (56.8%) and 16 females (43.2%). The mean age of the patients was 54 ± 19 years (range 19 to 86 years), with a mean age of 52 ± 20 years in men, and 56 ± 18 years in women (P = 0.52). The mean duration of ventilation was 6 ± 4 days (range 2 to 20 days). The mean duration of ventilation was 5 ± 2 days in men, and 6 ± 5 days in women (P = 0.42). A total of 16 patients (43.2%) developed ventilator-associated pneumonia (VAP); of whom, 50% were male and 50% female (P = 0.46). Patients who developed a pulmonary infection had a significantly longer duration of ventilation. The mean duration of ventilation was 8 ± 4 days in patients who had developed VAP, while this duration was 4 ± 2 days in the non-affected patients (P = 0.005). Overall, 17 patients died, and 7 of these deaths were attributed to VAP.

CONCLUSIONS:

The prevalence of VAP in this study was approximately 43%, which is relatively high. In total, the percentage of deaths due to VAP among the patients was 18.91%. Duration of ventilator support was significantly correlated with the prevalence of PI.

ref : Madani.S.J Articles