Respiratory distress observation scales to predict weaning outcome View Full Text


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Article Info

DATE

2022-06-06

AUTHORS

Maxens Decavèle, Emmanuel Rozenberg, Marie-Cécile Niérat, Julien Mayaux, Elise Morawiec, Capucine Morélot-Panzini, Thomas Similowski, Alexandre Demoule, Martin Dres

ABSTRACT

BackgroundWhether dyspnea is present before starting a spontaneous breathing trial (SBT) and whether it may affect the outcome of the SBT is unknown. Mechanical Ventilation—Respiratory Distress Observation Scale (MV-RDOS) has been proposed as a reliable surrogate of dyspnea in non-communicative intubated patients. In the present study, we sought (1) to describe the evolution of the MV-RDOS during a SBT and (2) to investigate whether MV-RDOS can predict the outcome of the SBT.MethodsProspective, single-center study in a twenty-two bed ICU in a tertiary center. Patients intubated since more 48 h who had failed a first SBT were eligible if they meet classical readiness to wean criteria. The MV-RDOS was assessed before, at 2-min, 15-min and 30-min (end) of the SBT. The presence of clinically important dyspnea was inferred by a MV-RDOS value ≥ 2.6.ResultsFifty-eight patients (age 63 [51–70], SAPS II 66 [51–76]; med [IQR]) were included. Thirty-three (57%) patients failed the SBT, whose 18 (55%) failed before 15-min. Twenty-five (43%) patients successfully passed the SBT. A MV-RDOS ≥ 2.6 was present in ten (17%) patients before to start the SBT. All these ten patients subsequently failed the SBT. A MV-RDOS ≥ 2.6 at 2-min predicted a SBT failure with a 51% sensibility and a 88% specificity (AUC 0.741 95% confidence interval [CI] 0.616–0.866, p = 0.002). Best cut-off value at 2-min was 4.3 and predicted SBT failure with a 27% sensibility and a 96% specificity.ConclusionDespite patients met classical readiness to wean criteria, respiratory distress assessed with the MV-RDOS was frequent at the beginning of SBT. Measuring MV-RDOS before to initiate a SBT could avoid undue procedure and reduce patient’s exposure to unnecessary mechanical ventilation weaning failure and distress. More... »

PAGES

162

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URI

http://scigraph.springernature.com/pub.10.1186/s13054-022-04028-7

DOI

http://dx.doi.org/10.1186/s13054-022-04028-7

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https://app.dimensions.ai/details/publication/pub.1148447284

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/35668459


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