Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt.
J Clin Monit Comput. 2021 Apr;35(2):405-412. doi: 10.1007/s10877-020-00483-1. Epub 2020 Feb 8.
We hypothesized that impairment of peripheral perfusion index (PPI) during spontaneous breathing trial (SBT) might be predictive of weaning failure. We included 44 consecutive, adult, patients, who were scheduled for weaning after at least 48 h of invasive mechanical ventilation in this prospective observational study. Weaning failure was defined as failed SBT or reintubation within 48 h of extubation. PPI readings were obtained before initiation of the SBT, and every 5 min till the end of the SBT. PPI ratio was calculated at every time point as: PPI value/ baseline PPI. The primary outcome was the accuracy of PPI ratio at the end of the SBT in detecting failed weaning. Forty-three patients were available for the final analysis. Eighteen patients (42%) were considered failed weaning. PPI ratio was higher in patients with successful weaning compared to patients with failed weaning during the last 15 min of the SBT. PPI ratio at the end of SBT was higher in patients with successful weaning compared to patients with failed weaning. PPI ratio at the end of SBT had good predictive ability for weaning failure {area under receiver operating characteristic curve (95% confidence interval): 0.833(0.688-0.929), cutoff value ≤ 1.41}. The change in PPI during SBT is an independent predictor for re-intubation. PPI could be a useful tool for monitoring the patient response to SBT. Patients with successful weaning showed higher augmentation of PPI during the SBT compared to re-intubated patients. Failure of augmenting the PPI by 41% at the end of SBT could predict re-intubation with negative predictive value of 95%. Clinical trial identifier: NCT03974568. https://clinicaltrials.gov/ct2/show/NCT03974568?term=ahmed+hasanin&draw=3&rank=17.
我们假设，在自主呼吸试验（SBT）期间外周灌注指数（PPI）的损害可能是撤机失败的预测指标。在这项前瞻性观察研究中，我们纳入了 44 名连续的成年患者，这些患者在接受有创机械通气至少 48 小时后计划进行撤机。撤机失败定义为 SBT 失败或拔管后 48 小时内重新插管。在 SBT 开始前、每 5 分钟和 SBT 结束时获取 PPI 读数。在每个时间点计算 PPI 比值，方法为：PPI 值/基础 PPI。主要结局是 SBT 结束时 PPI 比值在检测撤机失败中的准确性。43 名患者可进行最终分析。18 名患者（42%）被认为撤机失败。在 SBT 的最后 15 分钟，与撤机失败患者相比，成功撤机患者的 PPI 比值更高。与撤机失败患者相比，SBT 结束时的 PPI 比值在成功撤机患者中更高。SBT 结束时的 PPI 比值对撤机失败具有良好的预测能力{受试者工作特征曲线下面积（95%置信区间）：0.833（0.688-0.929），截断值≤1.41}。SBT 期间 PPI 的变化是重新插管的独立预测因子。PPI 可能是监测患者对 SBT 反应的有用工具。与重新插管患者相比，成功撤机患者在 SBT 期间 PPI 增加更多。SBT 结束时 PPI 增加不足 41%可预测重新插管，阴性预测值为 95%。临床试验标识符：NCT03974568。https://clinicaltrials.gov/ct2/show/NCT03974568？term=ahmed+hasanin&draw=3&rank=17。
