| Objective: To explore the application of metabolic vehicle to determine the resting energy expenditure(REE)in the clinical weaning process of mechanical ventilation patients and the relationship between REE and weaning outcome.Methods: From January 2017 to January 2018,we collected patients undergoing mechanical ventilation(MV)through orotracheal intubation in the Eastern Division of the Department of Intensive Care of the Suzhou Municipal Hospital,and included 68 patients who met clinical weaning conditions.The weaning process uses spontaneous breathing test(SBT).The patient entered the programmed weaning phase and began 3 minutes of SBT.During the 3 minutes of SBT,the patient's vital signs were closely observed by the physician.If the patient tolerated SBT for 3 minutes,the patient continued to breathe spontaneously for 30 to 120 minutes.The patient was able to tolerate Determine the success of the offline,prepare to remove the tracheal intubation,and give routine oxygen therapy after extubation.The changes in REE during the course of patient weaning were measured using a metabolic vehicle.The REE was collected before the patient's pre-evacuation(T0),1 h after the start of SBT(T1)and 12 h after extubation(T2).Observe the trends of REE during the weaning process at T0,T1,T2 time points.Patients who had been extubated by SBT and were not reintubated within 48 hours were included in the successful extubation group(S group),and the remaining patients were in the extubation failure group(F group).Those who passed SBT but were reinserted within 48 hours were reinserted.Tube group(R group).Comparing the difference between REE(REE-T0)and T1 time point REE(REE-T1)between S group and F group,the difference between REE(REE-T2)and T2 time point of S group and R group.To investigate the value of REE-T1,REE-T1 and REE-T0(?REE)in the weaning process.Results: 1.Compared with REE-T0,REE-T1,and REE-T2 in group S,REE-T0(1980.98±212.35 kcal)was compared with REE-T1(2072.28±223.84 kcal)and REE-T2(2044.35±132.43 kcal).Statistically significant(P<0.05),there was no significant difference between REE-T1 and REE-T2(P>0.05).2.Compared with REE-T1,REE-T1(2295.38±190.14kcal)in group F was higher than REE-T0(2037.06±152.39kcal),and the difference was statistically significant(P<0.05).There was no significant difference in REE-T0 between the S group and the F group(P>0.05).4.Compared with REE-T1 in group S and F,REE-T1 in group F was significantly higher than that in group S,and the difference was statistically significant(P<0.05).5.The REE-T1 predicts that the ROC curve for successful extubation is AUC of 0.804 and the best cutoff value is 2217 kcal.The sensitivity at this time is 82.5% and the specificity is 68.7%.?REE predicts that the ROC curve for successful extubation is AUC of 0.846,and the optimal cutoff value is 146 kcal.At this time,the sensitivity is 70% and the specificity is 87.5%.6.There was no significant difference in REE-T2 between group S and group R(P>0.05),but there was a trend of increase in REE-T2(2167.23±153.59 kcal)in group R compared with group S(2044.35±132.43 kcal).Conclusion: 1.During the weaning process,accompanied by changes in REE,even under the same low level of support conditions(PEEP?5cmH20,PSV<7cm H20),mechanical ventilation can reduce REE.2.The REE-T1 in the F group was significantly higher than that in the S group,suggesting that a significant increase in REE may indicate failure of extubation during weaning.REE-T1 and ?REE have certain value in predicting the outcome of extubation.3.Determination of REE after extubation may detect the risk of reintubation in the early stages and respond in a timely manner. |
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