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Abstract: Slide Presentations |

THE USE OF NONINVASIVE CARDIAC OUTPUT MONITORING IN IDENTIFYING FAILURE OF WEANING FROM MECHANICAL VENTILATION FREE TO VIEW

Maged A. Tanios, MD*; Sharon Sauser, RRT; Ramana Naidu, MD; Scott K. Epstein, MD
Author and Funding Information

St. Mary Medical Center/H-UCLA, Long Beach, CA


Chest


Chest. 2009;136(4_MeetingAbstracts):68S. doi:10.1378/chest.136.4_MeetingAbstracts.68S-c
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Abstract

PURPOSE:  A prospective study of serial noninvasive measurement of cardiac output (CO) during the 1st spontaneous breathing trial (SBT) to identify failure to wean associated with cardiac insufficiency.

METHODS:  Patients intubated for >24 hrs were weaned according to institutional protocol. Prior to the 1st SBT a noninvasive cardiac output device, NICO© (Philips Respironics, Murrysville, Pa., USA) was connected to the ventilator circuit. Three measurements were made prior to, at the beginning of, and at the end of the SBT.

RESULTS:  50 patients were tested: mean age 61±18yrs; 47% male;mean APACHEII 22±7; main reasons for intubation were Sepsis (33%) and ARDS (15%). 30% of patients failed the 1st SBT (F). In comparison to patients who passed (P) the 1st SBT those who failed had similar age (69±14 v.63±19ys;p=0.24),gender (61 v.49%female; p=0.39),and APACHEII score (23.1±6.7 v 1.2±7.5;p=0.34). The VD/VT measured prior to the SBT was higher for patients who failed (0.53±0.11v.0.47±0.08; p=0.035). The CO and Pulmonary Capillary Blood Flow (PCBF) were similar for both groups prior to weaning (P:5.8±2.2 v F:5.6±2.0;p>2) and (5.3±2 v. 4.6±1.4; p>2) and at the start of the SBT (6.0±2.3 v.5.9±1.8;p>2) and (5.5±2.5 v 4.8±1.5;p>2) respectively. The CO end of the SBT was higher for patients who passed (7.3 ± 3.1v.5.6 ± 2.0;p=0.03) the PCBF were also higher but not statistically significant (6.2±2.9v. 5.1±1.6;p>0.2). Patients who failed the first SBT and were unable to augment their CO passed subsequent SBTs after optimizing interventions while demonstrating an increased CO compared to their failed trials (5.5±1.1v.6.1±0.81;p=0.02). Interventions included aggressive diureses, dobutamine or NTG drips but not part of the study protocol. The patients who failed their 1st SBT had increased mean weaning time (3±2v.1±3d;p=0.028), ICU LOS (16±9v.9±7d;p=0.001), MV time (9±6v.6±4d;p=0.13) and hospital LOS (38±31v.30±54 d;p=0.04).

CONCLUSION:  A significant proportion of patients failing their 1st SBT have associated cardiac insufficiency as identified noninvasively by serial measurement of cardiac output.

CLINICAL IMPLICATIONS:  Early non-invasive method for identification of patients failing SBT due to cardiac insufficiency is feasible and may allow goal directed interventions to expedite the weaning process.

DISCLOSURE:  Maged Tanios, No Financial Disclosure Information; No Product/Research Disclosure Information

Wednesday, November 4, 2009

2:15 PM - 3:15 PM


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