| Objective:In patients with mechanical ventilation, assessed and compared theprediction weaning ability of Integrative Weaning Index (IWI) andCORE index (compliance, oxygenation, respiration, and effort).Methods:This study included45patients who with respiratory failure need formechanical ventilation (≥24hours). According to the mechanicalventilation time,45patients were divided into2groups, one was≥7days,and the other was <7days group. After the primary disease andrespiratory failure had been removed, the patients reached weaningprocess. The First steps was to implement withdraw machine screeningexperiment,if qualified,then started3min spontaneous breathing test(SBT) with the method of T tube. Before starting the SBT experimental,we recorded observation indexes: tidal volume (VT), respiratoryfrequency (f), the arterial oxygen saturation (SaO2), the arterial oxygenpartial pressure (PaO2), alveolar oxygen partial pressure (PaO2),dynamic compliance (Cdyn), static compliance (Cst,rs), maximalinspiratory pressure (MIP),and airway closure pressure (P0.1). Accordingto the formula to calculate the rapid-shallow-breathing index (RSBI):RSBI=f/VT, IWI=Cst, rs×SaO2/[f/VT],CORE=[Cdyn×(MIP/P0.1)×(PaO2/PAO2)]/f. All the data were collectedand analyzed by the statistical program SPSS16.0. Data were representedin mean±standard deviation. P <0.05value was considered statisticallysignificant between two groups. The measurement data were analyzed byvariance test, and counting card information were analyzed by the chi-square test. The ROC curves were calculated and compared withMedcalc11.4software. Our study mainly compared the ability of IWIand CORE to predict weaning from mechanical ventilation. And thencompared with the previous indexes: MIP, RSBI, P0.1, in order to evaluatethe differences between the various indicators.Results:1This study included45patients,39cases of male and6cases offemale. According to the mechanical ventilation time, the patients weredivided into2groups, one was≥7days and the other was <7days group.There were28cases in the group which the mechanical ventilation timewas <7days. There were17cases in the other group. There was nosignificant difference between two groups of patients with age (P=0.0635), but the acute physiology and chronic health evaluation(APACHE II), length of hospital stay, and length of ICU time hadsignificant difference (P=0.021, P=0.017, P=0.001).2In the group of which the mechanical ventilation time was <7days,there were21cases weaning successful in the first time and7casesof failure. The weaning success rate was75%.There was no statisticallysignificant difference in age, APACHE II, length of hospital stay, andlength of ICU time between the two groups (P=0.164, P=0.782, P=0.327,P=0.484).While the differences in mechanical ventilation time betweenthe two groups had statistical significance (P=0.022), and the time ofmechanical ventilation in successful group was shorter than that in failuregroup. There was statistically significant difference in IWI, CORE, RSBI,MIP,P0.1between the two groups(P=0.000, P=0.002, P=0.04, P=0.039),but there was no statistically significant difference in P0.1between the twogroups(P=0.179). The ability of IWI,CORE,RSBI, MIP, P0.1to predictweaning were tested with the area under the receiver-operatingcharacteristic (ROC) curve. No significant difference was found amongIWI, CORE and RSBI(P>0.05), but IWI was superior to MIP and P0.1with significant difference (P=0.0195,P=0.012). IWI had a good ability to predict weaning, and the CORE was superior to the P0.1(P=0.0259), butno obvious difference was found than that of MIP (P=0.0654). RSBI hadno obvious advantage over MIP and P0.1(P=0.144, P=0.3692).3In the group of which the mechanical ventilation time was≥7days,there were8cases weaning successful in the first time and9cases offailure. The weaning success rate was75%. There was no statisticallysignificant difference in age,APACHE II, length of hospital stay,length ofICU time, mechanical ventilation time between the two groups (P=0.572,P=0.779, P=0.39, P=0.579, P=0.396). There was statistically significantdifference in IWI, CORE, RSBI between successful group and failuregroup (P=0.008, P=0.018, P=0.004).There was no statistically significantdifference in MIP, P0.1between the two groups(P=0.98, P=0.867). Theability of these indexes to predict weaning was tested with the area underthe receiver-operating characteristic (ROC) curve. IWI, CORE and RSBIwere superior to the MIP and P0.1(P<0.05).Compare with MIP and P0.1,the index of IWI, CORE, and RSBI had a good ability to predict weaning.No significant difference was found among IWI, CORE and RSBI(P>0.05).4All45patients,the total weaning winners in the first time were29cases and16cases of failure. The weaning success rate was64.44%.Sixteen cases were failure in the first time of weaning. But in thefollowing72h, there were12cases weaning successful. There were6cases weaning successful in the following24h,4cases in the following48h,2cases in the following72h. Weaning success rate was no significantdifference in both groups (P=0.058).There was no statistically significantdifference in age, APACHE II,length of hospital stay,and length of ICUtime between the two groups(P=0.361, P=0.795,P=0.34,P=0.841). Whilethe differences in mechanical ventilation time had statistical significance(P=0.02) between the two groups. The time of mechanical ventilation insuccessful group was shorter than that in the failure group. There wasstatistically significant difference in IWI, CORE, RSBI, MIP, and P0.1 between the two groups (P=0.000, P=0.000,P=0.000,P=0.04,P=0.02).The ability of these indexes to predict weaning had no significantdifference between successful group and failure group (P>0.05). But bothIWI and CORE were superior to the MIP and P0.1(P<0.05).Conclusion:1In the group of which the mechanical ventilation time was <7days, compared with MIP,P0.1, IWI and CORE had a good ability topredict weaning, but had no obvious advantage over RSBI.2In the group of which the mechanical ventilation time was≥7days,IWI, CORE and RSBI had a good ability to predict weaning, nosignificant difference was found among them,but they were better thanother indexes.3In our study, both IWI and CORE had a good ability to predictweaning, but had no obvious advantage over RSBI. |
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