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Abstract
Critical car clinicians must carefully weigh the benefits of rapid for mechanical ventilation against the risks of premature trial of spontaneous breathing and extubation.
Our aim of work was study the capability of respiratory system mechanics as weaning parameters.
Patients and methods: in 30 patients who have been mechanically ventilated due to pulmonary causes of respiratory failure, we divided patients into 2 groups: ( Groups 1) in which weaning was postponed until certain values of lung mechanics have been reached ( targeted weaning ), and ( Group 2) in which patients undergone daily weaning trials once the general criteria of weaning have been fulfilled irrespective of their lung mechanics values.
Targeted weaning threshold values were as follows: static compliance> 33 ml / cm H2O , dynamic compliance> 22 ml/cm H2O resistance< 14cm H2O /L/ sec and auto PEEP < 5 cm H2O
Results : we found relatively high positive predictive values of the predetermined thresholds (0.866 and 0.83 in group 1 and 2 respectively). Btu group 2 showed a low negative predictive value ( 0.57 ) . patients of group 2 also showed no statistically significant difference in values of their different respiratory mechanics prior to successful and unsuccessful trials. ( p Value>0.05).
Targeted weaning group has showed less number of weaning trials and fewer incidences of re-incubation events with no increase in mechanical ventilation time or complications.
We concluded that respiratory mechanics were modest weaning predictors. Btu on the other hand, targeted weaning by respiratory mechanics constituted a much more economic and resource preserving protocol of weaning.
Key words:
Targeted weaning, daily weaning trials, respiratory mechanics, respiratory failure compliance resistance, auto PEEP.