Asian Nurs Res.  2020 Feb;14(1):30-35. 10.1016/j.anr.2020.01.002.

Transitional Percentage of Minute Volume as a Novel Predictor of Weaning from Mechanical Ventilation in Patients with Chronic Respiratory Failure

Affiliations
  • 1Division of Respiratory Therapy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
  • 2Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
  • 3School of Medicine, Tzu-Chi University, Hualien, Taiwan
  • 4Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
  • 5Department of Critical Care Medicine, Landseed International Hospital, Tao-Yuan, Taiwan

Abstract

Purpose
Some patients with respiratory failure fail initial weaning attempts and need prolonged mechanical ventilation (MV). Prolonged MV is associated with many complications and consumption of heathcare resources. Objective weaning indices help staffs to identify high-potential patients for weaning from the MV. Traditional weaning indices are not reliable in clinical practice. Transitional percentage of minute volume (TMV%) is a new index of the work of breathing. This study aimed to investigate the utility of TMV% in the prediction of weaning potential.
Methods
This study was prospectively performed including all patients with prolonged MV. Researchers recorded their demographics, TMV%, respiratory parameters, Acute Physiology and Chronic Health Evaluation II score, and laboratory data upon arrival at the respiratory care center. The factors associated with successful weaning were analyzed.
Results
Out of the 120 patients included, 84 (70.0%) were successfully weaned from MV. Traditional weaning indices such as rapid shallow breathing index could not predict the weaning outcome. TMV% was a valuable parameter as patients with a lower TMV%, higher tidal volume, higher hemoglobin, lower blood urea nitrogen, and lower Acute Physiology and Chronic Health Evaluation II scores had a higher rate of successful weaning. TMV%, tidal volume, and HCO3- levels were independent predictors of successful weaning, and the area under the curve was .79 in the logistic regression model.
Conclusion
TMV% is a novel and effective predictor of successful weaning. Patients with lower TMV% had a higher MV weaning outcome. Once patients with a high potential for successful weaning are identified, they should be aggressively weaned from MV as soon as possible.

Keyword

respiratory insufficiency; ventilators,; mechanical; work of breathing
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