CO2 response and duration of weaning from mechanical ventilation. 2011

Joan Maria Raurich, and Gemma Rialp, and Jordi Ibáñez, and Joan Antoni Llompart-Pou, and Ignacio Ayestarán
Intensive Care Unit, Hospital Universitario Son Dureta, Palma de Malorca, Illes Balears, Spain. joan.raurich@ssib.es

BACKGROUND The CO2 response test measures the hypercapnic drive response (which is defined as the ratio of the change in airway-occlusion pressure 0.1 s after the start of inspiratory flow [ΔP(0.1)] to the change in P(aCO2) [ΔP(aCO2)]), and the hypercapnic ventilatory response (which is defined as the ratio of the change in minute volume to ΔP(aCO2)). OBJECTIVE In mechanically ventilated patients ready for a spontaneous breathing trial, to investigate the relationship between CO2 response and the duration of weaning. METHODS We conducted the CO2 response test and measured maximum inspiratory pressure (P(Imax)) and maximum expiratory pressure (P(Emax)) in 102 non-consecutive ventilated patients. We categorized the patients as either prolonged weaning (weaning duration > 7 d) or non-prolonged weaning (≤ 7 d). RESULTS Twenty-seven patients had prolonged weaning. Between the prolonged and non-prolonged weaning groups we found differences in hypercapnic drive response (0.22 ± 0.16 cm H2O/mm Hg vs 0.47 ± 0.22 cm H2O/mm Hg, respectively, P < .001) and hypercapnic ventilatory response (0.25 ± 0.23 L/min/mm Hg vs 0.53 ± 0.33 L/min/mm Hg, respectively, P < .001). The optimal cutoff points to differentiate between prolonged and non-prolonged weaning were 0.19 cm H2O/mm Hg for hypercapnic drive response, and 0.15 L/min/mm Hg for hypercapnic ventilatory response. Assessed with the Cox proportional hazards model, both hypercapnic drive response and hypercapnic ventilatory response were independent variables associated with the duration of weaning. The hazard ratio of weaning success was 16.7 times higher if hypercapnic drive response was > 0.19 cm H2O/mm Hg, and 6.3 times higher if hypercapnic ventilatory response was > 0.15 L/min/mm Hg. Other variables (P(0.1), P(Imax), and P(Emax)) were not associated with the duration of the weaning. CONCLUSIONS Decreased CO2 response, as measured by hypercapnic drive response and hypercapnic ventilatory response, are associated with prolonged weaning.

UI MeSH Term Description Entries
D007362 Intensive Care Units Hospital units providing continuous surveillance and care to acutely ill patients. ICU Intensive Care Units,Intensive Care Unit,Unit, Intensive Care
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D002245 Carbon Dioxide A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. Carbonic Anhydride,Anhydride, Carbonic,Dioxide, Carbon
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006935 Hypercapnia A clinical manifestation of abnormal increase in the amount of carbon dioxide in arterial blood.
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D013997 Time Factors Elements of limited time intervals, contributing to particular results or situations. Time Series,Factor, Time,Time Factor
D015300 Ventilator Weaning Techniques for effecting the transition of the respiratory-failure patient from mechanical ventilation to spontaneous ventilation, while meeting the criteria that tidal volume be above a given threshold (greater than 5 ml/kg), respiratory frequency be below a given count (less than 30 breaths/min), and oxygen partial pressure be above a given threshold (PaO2 greater than 50mm Hg). Weaning studies focus on finding methods to monitor and predict the outcome of mechanical ventilator weaning as well as finding ventilatory support techniques which will facilitate successful weaning. Present methods include intermittent mandatory ventilation, intermittent positive pressure ventilation, and mandatory minute volume ventilation. Mechanical Ventilator Weaning,Respirator Weaning,Ventilator Weaning, Mechanical,Weaning, Mechanical Ventilator,Weaning, Respirator,Weaning, Ventilator

Related Publications

Joan Maria Raurich, and Gemma Rialp, and Jordi Ibáñez, and Joan Antoni Llompart-Pou, and Ignacio Ayestarán
July 1990, Critical care clinics,
Joan Maria Raurich, and Gemma Rialp, and Jordi Ibáñez, and Joan Antoni Llompart-Pou, and Ignacio Ayestarán
January 1985, Soins. Chirurgie (Paris, France : 1982),
Joan Maria Raurich, and Gemma Rialp, and Jordi Ibáñez, and Joan Antoni Llompart-Pou, and Ignacio Ayestarán
October 1998, Critical care clinics,
Joan Maria Raurich, and Gemma Rialp, and Jordi Ibáñez, and Joan Antoni Llompart-Pou, and Ignacio Ayestarán
March 1983, Critical care update,
Joan Maria Raurich, and Gemma Rialp, and Jordi Ibáñez, and Joan Antoni Llompart-Pou, and Ignacio Ayestarán
May 2007, The European respiratory journal,
Joan Maria Raurich, and Gemma Rialp, and Jordi Ibáñez, and Joan Antoni Llompart-Pou, and Ignacio Ayestarán
January 2000, Critical care (London, England),
Joan Maria Raurich, and Gemma Rialp, and Jordi Ibáñez, and Joan Antoni Llompart-Pou, and Ignacio Ayestarán
January 1999, International anesthesiology clinics,
Joan Maria Raurich, and Gemma Rialp, and Jordi Ibáñez, and Joan Antoni Llompart-Pou, and Ignacio Ayestarán
August 1991, The Surgical clinics of North America,
Joan Maria Raurich, and Gemma Rialp, and Jordi Ibáñez, and Joan Antoni Llompart-Pou, and Ignacio Ayestarán
April 2007, Critical care clinics,
Joan Maria Raurich, and Gemma Rialp, and Jordi Ibáñez, and Joan Antoni Llompart-Pou, and Ignacio Ayestarán
October 2011, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians,
Copied contents to your clipboard!