Acute Crit Care.  2018 Nov;33(4):260-268. 10.4266/acc.2018.00276.

Clinical Application of Modified Burns Wean Assessment Program Scores at First Spontaneous Breathing Trial in Weaning Patients from Mechanical Ventilation

• Jeong ES
• Lee K

• KMID: 2441244
• DOI: http://doi.org/10.4266/acc.2018.00276

Abstract

BACKGROUND
The purpose of this study was to evaluate the clinical application of modified Burns Wean Assessment Program (m-BWAP) scoring at first spontaneous breathing trial (SBT) as a predictor of successful liberation from mechanical ventilation (MV) in patients with endotracheal intubation.
METHODS
Patients requiring MV for more than 72 hours and undergoing more than one SBT in a medical intensive care unit (ICU) were prospectively enrolled over a 3-year period. The m-BWAP score at first SBT was obtained by a critical care nursing practitioner.
RESULTS
A total of 103 subjects were included in this study. Their median age was 69 years (range, 22 to 87 years) and 72 subjects (69.9%) were male. The median duration from admission to first SBT was 5 days (range, 3 to 26 days), and the rate of final successful liberation from MV was 84.5% (n=87). In the total group of patients, the successful liberation from MV group at first SBT (n=65) had significantly higher m-BWAP scores than did the unsuccessful group (median, 60; range, 43 to 80 vs. median, 53; range, 33 to 70; P < 0.001). Also, the area under the m-BWAP curve for predicting successful liberation of MV was 0.748 (95% confidence interval, 0.650 to 0.847), while the cutoff value based on Youden's index was 53 (sensitivity, 76%; specificity, 64%).
CONCLUSIONS
The present data show that the m-BWAP score represents a good predictor of weaning success in patients with an endotracheal tube in place at first SBT.

Keyword

endotracheal intubation; intensive care unit; mechanical ventilator; ventilator weaning

MeSH Terms

Burns*
Critical Care Nursing
Humans
Intensive Care Units
Intubation, Intratracheal
Male
Prospective Studies
Respiration*
Respiration, Artificial*
Sensitivity and Specificity
Ventilator Weaning
Ventilators, Mechanical
Weaning*

Figure

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  Figure 1. Ventilator weaning protocol. SpO2: blood oxygen saturation; HR: heart rate; PaO2: partial pressure of oxygen; FiO2: fraction of inspired oxygen; PaCO2: partial pressure of carbon dioxide; PEEP: positive end-expiratory pressure; Pi: inspiratory pressure; ST: ST segment on electrocardiogram.

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  Figure 2. Flowchart of recruited and enrolled study participants and clinical outcomes of all enrolled patients. ICU: Intensive care unit; SBT: spontaneous breathing trial.

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  Figure 3. Receiver operating characteristic curves for modified Burns Wean Assessment Program (m-BWAP) score, rapid shallow breathing index (RSBI), and maximal inspiratory pressure (Pimax) at first spontaneous breathing trial for predicting successful liberation from mechanical ventilation were drawn. The areas under the curve (AUCs) for m-BWAP, RSBI, and Pimax were 0.748 (95% confidence interval [CI], 0.650 to 0.847; P<0.001), 0.637 (95% CI, 0.528 to 0.745; P=0.014), and 0.545 (95% CI, 0.429 to 0.661; P= 0.443), respectively. The AUC for m-BWAP was significantly higher than that for Pimax (P=0.005).

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