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A4237
October 15, 2013
1:00:00 PM - 2:00:00 PM
Room Room 104-Area D
Progressive Evaluation of Integrated Pulmonary Index (IPI) During Spontaneous Breathing Trials in Medical and Surgical Patients
Vikas Kumar, M.D., Arthur Taft, R.R.T., Susan Johnson, R.R.T., Ramona Herrington, R.T., Manuel Castresana, M.D.
Georgia Regents University, Augusta, Georgia, United States
Introduction:

Rapidly removing patients from mechanical ventilation decreases costs and reduces complications. Determining the best time to extubate patients in critical care areas can be challenging. Most clinicians use traditional values like vital capacity, negative inspiratory force, rapid shallow breathing index, during a spontaneous breathing trial (SBT). The integrated pulmonary index (IPI), is an index of respiratory status derived from capnography and pulse oximetry data (PETCO2, RR, SPO2, and HR) and has been shown to correlate well with respiratory function in a variety of settings, but limited data exists on IPI during weaning from mechanical ventilation. This study tested the hypothesis that average IPI is higher during successful SBTs than unsuccessful SBTs.

Methods:

This IRB approved, prospective, observational trial was performed on mechanically ventilated patients in critical care patients intubated for both medical and surgical indications. All patients received standard of care and no intervention was performed specifically for this study. All subjects were evaluated for weaning per hospital protocol and clinicians were blinded to IPI. IPI was continuously recorded during each SBT. At the end of each SBT, the outcomes (pass/fail) were determined by the critical care team, independent of IPI. Recorded data was averaged over the first 30 minutes of SBT and analyzed to determine the ability of IPI to predict weaning evaluation outcome. Statistical analysis was performed using Mann-Whitney Rank Sum Test.

Results:

We studied43 patients (26 males, 17 females) with mean age of 59.7 ± 13.6 years, and BMI 31.6 ± 8.2 who received 57 SBTs. Statistical analysis revealed that median IPI (med: 25%ile-75%ile) was higher in passing (9.09: 8.04-9.76) than failing 7.87: 6.26-8.73) SBTs (p < .005)

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