Ellens Troy, Kaur Ramandeep, Roehl Kelly, Dubosky Meagan, Vines David L
Quality Improvement Systems, James. M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA.
Can J Respir Ther. 2019 Jul 9;55:65-71. doi: 10.29390/cjrt-2019-007. eCollection 2019.
Weaning predictors can help liberate patients in a timely manner from mechanical ventilation. Ventilatory equivalent for oxygen (VEqO), a surrogate for work of breathing and a measure of the efficiency of breathing, may be an important noninvasive alternative to other weaning predictors. Our study's purpose was to observe any differences in VEqO between extubation outcome groups.
Employing a metabolic cart, oxygen consumption ( O), minute volume (VE), tidal volume (VT), and breathing frequency were recorded during a spontaneous breathing trial (SBT) to calculate VEqO and the rapid shallow breathing index (RSBI) in 34 adult participants in the intensive care unit. Five-breath means of VEqO and the RSBI collected throughout the SBT were examined between SBT pass and fail groups and extubation pass and fail groups using the Mann-Whitney U test with < 0.05.
Data from 31 participants were analyzed between SBT outcome groups. Data from 20 participants were examined for extubation outcome after a successful SBT. Median (interquartile range) VEqO was not different between extubation groups. Participants who passed the SBT had a higher median VEqO than those who did not at the midpoint (25.3 L/L O [22-33 L/L O] vs. 23.7 L/L O [18-24 L/L O], = 0.035) and at the end (25.5 L/L O [23-34 L/L O] vs. 21.3 L/L O [20-24 L/L O], = 0.017) of the SBT.
VEqO may show differences in SBT outcomes, but not differences between extubation outcomes. VEqO may be able to detect differences in work during an SBT, but may not be able to predict change in workload in the respiratory system after extubation. The small sample size may also have prevented any differences in extubation outcomes to be shown.
VEqO was higher in patients that passed their SBT. VEqO was not useful in identifying extubation success or failure in adult mechanically ventilated patients.
撤机预测指标有助于及时使患者脱离机械通气。氧通气当量（VEqO）作为呼吸功的替代指标及呼吸效率的衡量指标，可能是其他撤机预测指标的重要无创替代指标。本研究的目的是观察拔管结局组之间VEqO的差异。
使用代谢车，在34名重症监护病房成年参与者的自主呼吸试验（SBT）期间记录氧耗量（O）、分钟通气量（VE）、潮气量（VT）和呼吸频率，以计算VEqO和快速浅呼吸指数（RSBI）。使用Mann-Whitney U检验（α<0.05），在SBT通过和未通过组以及拔管通过和未通过组之间检查整个SBT期间收集的VEqO和RSBI的五次呼吸平均值。
在SBT结局组之间分析了31名参与者的数据。对20名在成功SBT后进行拔管结局检查的参与者的数据进行了分析。拔管组之间的VEqO中位数（四分位间距）没有差异。通过SBT的参与者在SBT中点（25.3L/L O[22-33L/L O]对23.7L/L O[18-24L/L O]，P=0.035）和结束时（25.5L/L O[23-34L/L O]对21.3L/L O[20-24L/L O]，P=0.017）的VEqO中位数高于未通过的参与者。
VEqO可能在SBT结局中显示出差异，但在拔管结局之间没有差异。VEqO可能能够检测SBT期间的工作差异，但可能无法预测拔管后呼吸系统工作量的变化。小样本量也可能阻止了拔管结局显示出任何差异。
通过SBT的患者的VEqO较高。VEqO在识别成年机械通气患者的拔管成功或失败方面没有用处。
