Weaning prediction esophageal pressure monitoring complements readiness testing

Amal Jubran, Brydon J.B. Grant, Franco Laghi, Sairam Parthasarathy, Martin J. Tobin

Research output: Contribution to journalArticlepeer-review

69 Scopus citations

Abstract

Several variables are recommended for Identifying if a patient is ready for a trial of weaning from mechanical ventilation, but there is no agreement as to whether monitoring any variable during the trial enhances patient management. To determine whether repeated measurements of esophageal pressure throughout a trial are more reliable than measurements of esophageal pressure or frequency-to-V T ratio during the first minute of the trial, we studied 60 patients. A trend Index that quantified esophageal pressure swings over time was more reliable than the first-minute measurements: sensitivity, 0.91, and specificity, 0.89. Area under receiver operating characteristic curve for trend Index (0.94) was greater than for first-minute measurement of esophageal pressure (0.44, p < 0.05) and tended to be greater than that for frequency-to-V T ratio (0.78, p = 0.13). The likelihood ratio was highest for the trend Index (8.2, p < 0.05). The advantage of the trend Index may be related to the progressive Increase in esophageal pressure throughout a failed weaning trial, whereas breathing pattern changed little after 2 minutes of spontaneous breathing. In conclusion, continuous monitoring of esophageal pressure swings during a spontaneous breathing trial provides additional guidance in patient management over tests used for deciding when to initiate weaning.

Original languageEnglish (US)
Pages (from-to)1252-1259
Number of pages8
JournalAmerican journal of respiratory and critical care medicine
Volume171
Issue number11
DOIs
StatePublished - Jun 1 2005
Externally publishedYes

Keywords

  • Esophageal pressure
  • Monitoring
  • Weaning

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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