Georgakas Ioannis, Boutou Afroditi K, Pitsiou Georgia, Kioumis Ioannis, Bitzani Milly, Matei Kristina, Argyropoulou Paraskevi, Stanopoulos Ioannis
Respiratory Failure Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.
1st Intensive Care Unit, "G. Papanikolaou" Hospital, Thessaloniki, Greece.
Open Respir Med J. 2018 Mar 26;12:11-20. doi: 10.2174/1874306401812010011. eCollection 2018.
Weaning from mechanical ventilation is a key element in the care of critically ill patients, and Spontaneous Breathing Trial (SBT) is a crucial step in this procedure. This nested case-control study aimed to evaluate whether central oxygen saturation (ScvO) values and their changes could independently predict the SBT outcome among mechanically ventilated patients.
A prospective cohort of patients who were mechanically ventilated for at least 48hours and fulfilled the criteria of readiness to wean constituted the study population. All patients attempted a SBT and were then categorized in SBT success group and SBT failure group, based on a combination of criteria which indicated whether SBT was successful or not. Multivariate binary logistic regression analysis was utilized to indicate the independent predictors of SBT success, while the Receiver Operating Characteristic (ROC) curves were used to demonstrate the diagnostic accuracy of these independent predictors.
Seventy-seven patients 69(18-86) years old; 62.3% male) constituted the study population. SBT was successful among 63.6% of them. A decrease in ScvO values (ΔScvO) < 4% between the beginning and the end of the trial independently predicted the successful outcome (OR=18.278; 95% CI=4.017-83.163), along with age, Hemoglobin concentration (Hb) and arterial oxygen saturation (SaO). Diagnostic accuracy for ΔScvO alone (ROC area=0.715) was slightly superior to that of either SaO (0.625) or Hb (0.685) to predict SBT success.
ScvO is an independent predictor of the weaning outcome and its evaluation may further facilitate the accurate categorization among those patients who pass or fail the SBT.
机械通气撤机是重症患者护理的关键环节，而自主呼吸试验（SBT）是该过程中的关键步骤。这项巢式病例对照研究旨在评估中心氧饱和度（ScvO）值及其变化是否能独立预测机械通气患者的SBT结果。
前瞻性队列研究纳入了机械通气至少48小时且符合撤机准备标准的患者作为研究对象。所有患者均尝试进行SBT，然后根据表明SBT是否成功的综合标准分为SBT成功组和SBT失败组。采用多因素二元逻辑回归分析来确定SBT成功的独立预测因素，同时使用受试者工作特征（ROC）曲线来展示这些独立预测因素的诊断准确性。
77例患者（年龄69[18 - 86]岁；男性占62.3%）构成了研究人群。其中63.6%的患者SBT成功。试验开始和结束时ScvO值的下降（ΔScvO）<4%可独立预测成功结果（OR = 18.278；95%CI = 4.017 - 83.163），同时还有年龄、血红蛋白浓度（Hb）和动脉血氧饱和度（SaO）。单独使用ΔScvO预测SBT成功的诊断准确性（ROC曲线下面积 = 0.715）略优于SaO（0.625）或Hb（0.685）。
ScvO是撤机结果的独立预测因素，对其评估可能有助于进一步准确区分SBT成功或失败的患者。
