Research & Innovation
Publications
Mechanical power density, spontaneous breathing indexes, and prolonged weaning failure
PMU Author
Simon Ulrich Jaeger
All Authors
Alessandro Ghiani, Swenja Walcher, Azal Lutfi, Joanna Paderewska, Simon Ulrich Jaeger, Nikolaus Kneidinger, Stephanie Susanne Stecher, Franziska Christina Trudzinski, Claus Neurohr
Journal association
Scientific reports
Abstract
A prospective observational study comparing mechanical power density (MP normalized to dynamic compliance) with traditional spontaneous breathing indexes (e.g., predicted body weight normalized tidal volume [VT/PBW], rapid shallow breathing index [RSBI], or the integrative weaning index [IWI]) for predicting prolonged weaning failure in 140 tracheotomized patients. We assessed the diagnostic accuracy of these indexes at the start and end of the weaning procedure using ROC curve analysis, expressed as the area under the receiver operating characteristic curve (AUROC). Weaning failure occurred in 41 out of 140 patients (29%), demonstrating significantly higher MP density (6156 cmH 2O 2/min [4402-7910] vs. 3004 cmH 2O 2/min [2153-3917], P < 0.01), lower spontaneous VT/PBW (5.8 mL*kg -1 [4.8-6.8] vs. 6.6 mL*kg -1 [5.7-7.9], P < 0.01) higher RSBI (68 min -1*L -1 [44-91] vs. 55 min -1*L -1 [41-76], P < 0.01) and lower IWI (41 L 2/cmH 2O*%*min*10 -3 [25-72] vs. 71 L 2/cmH 2O*%*min*10 -3 [50-106], P < 0.01) and at the end of weaning. MP density was more accurate at predicting weaning failures (AUROC 0.91 [95%CI 0.84-0.95]) than VT/PBW (0.67 [0.58-0.74]), RSBI (0.62 [0.53-0.70]), or IWI (0.73 [0.65-0.80]), and may help clinicians in identifying patients at high risk for long-term ventilator dependency.
Keywords
Humans, Prospective Studies, RESPIRATION, Ventilator Weaning/methods, Tidal Volume/physiology