maximal inspiratory pressure and extubation

The aim of this study was to establish predictors for successfully planned extubation, which can be followed by medical personnel. The patients who were admitted to the adult intensive care unit of a tertiary hospital and met the following criteria between January 2005 and December 2014 were collected retrospectively: intubation > 48 hours; and candidate for extubation. The patient characteristics, including disease severity, rapid shallow breath index (RSBI), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), cuff leak test (CLT) before extubation, and outcome, were recorded...

Objective: To evaluate the effectiveness of prophylactic, non-invasive ventilation (NIV) on respiratory function in seven- to 16-year-old children in the post-operative phase of cardiac surgery. Method: A randomized, controlled trial with 50 children who had undergone cardiac surgery with median sternotomy. After extubation, patients were randomly assigned to one of two groups: control group (n=26), which received instructions regarding posture, early ambulation, and cough stimulation, and CPAP group (continuous positive airway pressure; n=24), which received the same instructions as the control group and CPAP=10 cmH20 twice daily for 30 minutes from the 1st to the 5th post-operative day (POD)...

BACKGROUND: Diaphragm dysfunction in mechanically ventilated patients is associated with poor outcome. Maximal inspiratory pressure (MIP) can be used to evaluate inspiratory muscle function. However, it is unclear whether respiratory weakness is independently associated with long-term mortality. The aim of this study was to determine if low MIP is independently associated with one-year mortality. METHODS: We conducted a prospective observational cohort study in an 18-bed ICU...

RATIONALE: Diaphragm atrophy and dysfunction have been reported in humans during mechanical ventilation, but the prevalence, causes, and functional impact of changes in diaphragm thickness during routine mechanical ventilation for critically ill patients are unknown. OBJECTIVES: To describe the evolution of diaphragm thickness over time during mechanical ventilation, its impact on diaphragm function, and the influence of inspiratory effort on this phenomenon. METHODS: In three academic intensive care units, 107 patients were enrolled shortly after initiating ventilation along with 10 nonventilated intensive care unit patients (control subjects)...

QUESTION: Does inspiratory muscle training improve inspiratory muscle strength in adults receiving mechanical ventilation? Does it improve the duration or success of weaning? Does it affect length of stay, reintubation, tracheostomy, survival, or the need for post-extubation non-invasive ventilation? Is it tolerable and does it cause adverse events? DESIGN: Systematic review of randomised trials. PARTICIPANTS: Adults receiving mechanical ventilation...

OBJECTIVES: Between 10% and 20% of children submitted to mechanical ventilation in the pediatric intensive care unit present extubation failure. Several ventilatory indexes have been proposed to predict extubation failure. The aim of this study was to analyze the accuracy of these indices in predicting successful extubation in children and to evaluate these variables according to the age of the patient and the specific disease. METHODS: A prospective observational study including all children submitted to mechanical ventilation in a Brazilian referral pediatric intensive care unit was conducted between August 2007 and August 2008...

OBJECTIVE: To study the result of respiratory multiple index(compliance, respiratory rate, oxygenation, pressure, CROP) in predicting weaning from mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: A prospective study was conducted. Two hundred and fifteen patients weaning from mechanical ventilation with AECOPD in intensive care unit (ICU) of five tertiary hospitals from September 2010 to October 2012 were enrolled...

QUESTION: Does inspiratory muscle training accelerate weaning from mechanical ventilation? Does it improve respiratory muscle strength, tidal volume, and the rapid shallow breathing index? DESIGN: Randomised trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS: 92 patients receiving pressure support ventilation were included in the study and followed up until extubation, tracheostomy, or death. INTERVENTION: The experimental group received usual care and inspiratory muscle training using a threshold device, with a load of 40% of their maximal inspiratory pressure with a regimen of 5 sets of 10 breaths, twice a day, 7 days a week...

BACKGROUND: Patients with cerebral infarction often present impaired consciousness and unsatisfactory extubation. We aimed to assess the respiratory mechanics components that might be associated with the success of extubation in stroke patients. METHODS: Twenty consecutive patients with stroke who needed mechanical ventilation support were enrolled. The maximal inspiratory pressure, gastric and the esophageal pressure (Pdi/Pdimax), minute volume, respiratory rate, static compliance, airway resistance, rapid and superficial respiration index (RSRI), inspiratory time/total respiratory cycle (Ti/Ttot), and PaO(2)/FiO(2) were measured...

BACKGROUND: Patients with cerebral infarction often present impaired consciousness and unsatisfactory extubation. We aimed to assess the respiratory mechanics components that might be associated with the success of extubation in stroke patients. METHODS: Twenty consecutive patients with stroke who needed mechanical ventilation support were enrolled. The maximal inspiratory pressure, gastric and the esophageal pressure (Pdi/Pdimax), minute volume, respiratory rate, static compliance, airway resistance, rapid and superficial respiration index (RSRI), inspiratory time/total respiratory cycle (Ti/Ttot), and PaO(2)/FiO(2) were measured...

BACKGROUND: Predictor indexes are often included in weaning protocols and may help the intensive care unit (ICU) staff to reach expected weaning outcome in patients on mechanical ventilation. OBJECTIVE: The objective of this study is to evaluate the potential of weaning predictors during extubation. DESIGN: This is a prospective clinical study. SETTINGS: The study was conducted in 3 medical-surgical ICUs. PATIENTS: Five hundred consecutive unselected patients ventilated for more than 48 hours were included...

BACKGROUND: The effectiveness of noninvasive ventilation (NIV) after extubation in preventing post-extubation respiratory failure is still controversial. METHODS: We conducted a prospective, multicenter randomized controlled study involving patients on mechanical ventilation for > 48 hours who tolerated a 2-hour spontaneous breathing trial and were subsequently extubated. The patients were randomized to NIV or standard medical therapy. Re-intubation rate within 72 hours was the primary outcome measure...

PURPOSE: To determine the feasibility of daily titration of the neurally adjusted ventilatory assist (NAVA) level in relation to the maximal diaphragmatic electrical activity (EAdi(maxSBT)) measured during a spontaneous breathing trial (SBT) during pressure support ventilation (PSV). METHODS: The study included 15 consecutive patients in whom mechanical ventilation weaning was initiated with the NAVA mode. EAdi(maxSBT) was determined daily during an SBT using PSV with 7 cmH2O of inspiratory pressure and no positive end-expiratory pressure (PEEP)...

OBJECTIVE: To determine whether composite extubation indices can predict extubation outcome in preterm infants. DESIGN: Prospective observational study. SETTING: Level III neonatal intensive care unit. PATIENTS: Fifty-six preterm infants cared for in the neonatal intensive care unit of a tertiary teaching hospital during 2007 and 2008. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The study consisted of two parts...

QUESTIONS: Does inspiratory muscle training improve maximal inspiratory pressure in intubated older people? Does it improve breathing pattern and time to wean from mechanical ventilation? DESIGN: Randomised trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS: 41 elderly, intubated adults who had been mechanically ventilated for at least 48 hr in an intensive care unit. INTERVENTION: The experimental group received usual care plus inspiratory muscle training using a threshold device, with an initial load of 30% of their maximal inspiratory pressure, increased by 10% (absolute) daily...

OBJECTIVE: To evaluate demographic characteristics, mechanical-ventilation parameters, blood gas values, and ventilatory indexes as predictors of extubation failure in infants with severe acute bronchiolitis. METHODS: We conducted a prospective observational study from March 2004 to September 2005 with consecutive infants (ages 1-12 months) with severe acute bronchiolitis and considered ready to be extubated. We calculated mean airway pressure and oxygenation index...

RATIONALE: Indices that assess the load on the respiratory muscles, such as the tension-time index (TTI), may predict extubation outcome. OBJECTIVES: To evaluate the performance of a noninvasive assessment of TTI, the respiratory muscle tension time index (TTmus), by comparison to that of the diaphragm tension time index (TTdi) and other predictors of extubation outcome in ventilated children. METHODS: Eighty children (median [range] age 2...

INTRODUCTION: The use of noninvasive positive-pressure mechanical ventilation (NPPV) has been investigated in several acute respiratory failure situations. Questions remain about its benefits when used in weaning patients from invasive mechanical ventilation (IMV). The objective of this study was to evaluate the use of bi-level NPPV for patients who fail weaning from IMV. METHODS: This experimental randomized clinical trial followed up patients undergoing IMV weaning, under ventilation for more than 48 hours, and who failed a spontaneous breathing T-piece trial...

INTRODUCTION: It is known that mechanical ventilation and many of its features may affect the evolution of inspiratory muscle strength during ventilation. However, this evolution has not been described, nor have its predictors been studied. In addition, a probable parallel between inspiratory and limb muscle strength evolution has not been investigated. OBJECTIVE: To describe the variation over time of maximal inspiratory pressure during mechanical ventilation and its predictors...

OBJECTIVE: Although critical illness neuromyopathy might interfere with weaning from mechanical ventilation, its respiratory component has not been investigated. We designed a study to assess the level of respiratory muscle weakness emerging during the intensive care unit stay in mechanically ventilated patients and to examine the correlation between respiratory and limb muscle strength and the specific contribution of respiratory weakness to delayed weaning. DESIGN: Prospective observational study...