The Change of Central Vein Oxygen Saturation Level during Spontaneous Breathing Trial as a Predictor of Successful Extubation in Intensive Care Unit.

BACKGROUND

Weaning from mechanical ventilation is an essential step in the care of critically ill patients. Central venous oxygen saturation (ScvO) could reflect tissue oxygenation.

OBJECTIVE

The evaluation of the difference in ScvO values at the beginning and end of the Spontaneous Breathing Trial (SBT) can be used as a predictor of successful extubation in critically ill patients.

METHODS

This cross-sectional study was conducted in the ICU of Prof. Dr. I.G.N.G. Ngoerah Hospital from July to August 2024. This study involved 42 adult patients aged 18-65 who were using mechanical ventilation during their admission to the ICU. All patients had central venous access, were clinically ready for mechanical ventilation weaning, and could attempt SBT for 30-120 minutes with a rapid shallow breathing index (RSBI) of less than 105.

RESULTS: All patients underwent 30-120 minutes of SBT. ScvO levels were measured at the beginning of SBT (first minute) and at 30 minutes after SBT started, and the change in ScvO level was recorded (ΔScvO). Patients with RSBI < 105 measured during SBT were extubated. Extubation failure was defined as the need for re-intubation, or patients died within 48 hours after extubation. Of 42 patients, 37 patients (89.1%) were successfully extubated. There was a significant difference in ΔScvO between successfully extubated patients and those who failed 
(-2.89±1.63 -8.2±4.27; p=0.049). The ROC curve analysis showed that a decrease in ScvO ≤4.5% was the most optimal cut-off for a predictor of successful extubation with a sensitivity of 81.1%, specificity of 60%, positive predictive value of 93.8% and negative predictive value of 70%.

CONCLUSION

The difference in ScvO between the beginning and after 30 minutes of SBT was a valuable early predictor for successful extubation from mechanical ventilation.