Routine use of weaning predictors not so fast 英文参考文献.docVIP

Available online /content/13/5/197 Commentary Routine use of weaning predictors: not so fast Scott K Epstein Office of Educational Affairs, Tufts University School of Medicine, 145 Harrison Avenue, Room 317, Boston, MA 02111, USA Corresponding author: Scott K Epstein, Scott.Epstein@ Published: 21 October 2009 Critical Care 2009, 13:197 (doi:10.1186/cc8121) This article is online at /content/13/5/197 ? 2009 BioMed Central Ltd See related research by Nemer et al., /content/13/5/R152 Abstract ting measurements of Cdyn, MIP (pressure), PaO2/PAO2 (oxygenation) and the respiratory rate [3]: Weaning from mechanical ventilation remains a major challenge for critical care physicians. Because subjective criteria are inaccurate, objective measurements consisting of clinical criteria and CROP (ml/breath/minute) = physiologic tests (weaning predictors) have been used to facilitate decision-making. An integrated weaning index calculated as the product of static compliance and arterial oxygen saturation divided by the frequency–tidal volume ratio appears to be more accurate than other currently available predictors. Despite the accuracy of this new test, a beneficial effect on outcome is yet to be proven. [Cdyn × MIP × (PaO2/PAO2)] / respiratory rate In a prospective study, a CROP of 13 ml/breath/minute yielded a positive predictive value and a negative predictive value of 0.71 and 0.70, respectively, but was less accurate than the f/VT. Jabour and colleagues examined a weaning index, the product of a modified pressure time index and an index of gas exchange efficiency. In a post-hoc analysis, the Invasive mechanical ventilation provides support during recovery from acute respiratory failure but results in complica- tions, and longer duration of intubation is associated with increased mortality. Patients should therefore be weaned and extubated as soon as it is safe