Critical Care |

Predictors of Time-to-Wean Among African Americans With Acute Respiratory Distress Syndrome FREE TO VIEW

Anthony Otekeiwebia, MD; Marilyn Foreman; Marshaleen Henriques-Forsythe, MD; Priscilla Pemu, MD; Ingrid Pinzon
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Morehouse School of Medicine, Atlanta, GA

Chest. 2014;146(4_MeetingAbstracts):204A. doi:10.1378/chest.1962524
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SESSION TITLE: ARDS/Lung Injury Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Studies have attempted to identify predictors of weaning outcome in acute respiratory distress syndrome (ARDS), but reports have been inconsistent due to different criteria for ARDS and heterogeneous patient populations. The primary objective of this study was to determine the predictors of time to wean from mechanical ventilation (TTW) in a cohort of African Americans with acute respiratory distress syndrome as defined by the Berlin Criteria.

METHODS: The following characteristics were retrospectively collated on day one of mechanical ventilation among 119 patients with acute respiratory distress syndrome; age, sex, body mass index, Acute Physiology and Chronic Health Evaluation (APACHE) II, peak airway pressure, respiratory rate, tidal volume, positive end-expiratory pressure (PEEP), arterial oxygen tension (PaO2), fractional inspired oxygen (FiO2), arterial carbon dioxide tension (PaCO2), oxygenation index (OI), serum creatinine, serum bilirubin, serum albumin, platelet count, Glasgow Coma Scale, and the use of vasopressors. Oxygenation index (OI) was calculated as (mean airway pressure X FiO2 X 100) ÷ PaO2. Rapid shallow breathing index (RSBI) was calculated as respiratory frequency (in breaths per minute) divided by tidal volume (in liters). Time-to-event analyses were used to model TTW. Kaplan-Meier estimates were used to determine the cumulative probability of successful weaning within the hospital stay and log-rank tests for comparison of the TTW between groups.

RESULTS: The TTW was shorter in patients with a normal creatinine level (0.6 to 1.4 mg/dL), APACHEII<25, a rapid shallow breathing index (RSBI) of < 105, serum albumin >2mg/dl, Oxygenation index (OI) <15, and those not on vasopressors. We found an interaction between RSBI and OI (p = 0.025) such that patients with an RSBI of <105 and OI of < 15 had a median TTW of 10 days versus 14 day in patients with OI >15.

CONCLUSIONS: In our patient population, a predictive model based on respiratory variables (RSBI and OI), disease severity (APACHEII), serum albumin and cardiovascular function on day 1 of ventilation is able to reliably predict time to wean from mechanical ventilation with ARDS.

CLINICAL IMPLICATIONS: With escalating cost of care and limited resources in the intensive care unit, prompt liberation from mechanical ventilation are encouraged. A good knowledge of the estimated time frame of the likelihood of liberation from mechanical ventilation will be crucial in cost projection and resource management.

DISCLOSURE: The following authors have nothing to disclose: Anthony Otekeiwebia, Marilyn Foreman, Marshaleen Henriques-Forsythe, Priscilla Pemu, Ingrid Pinzon

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