New integrated weaning indices from mechanical ventilation: A derivation-validation observational multicenter study

Amir Vahedian-Azimi; Keivan Gohari-Moghadam; Farshid Rahimi-Bashar; Abbas Samim; Masoum Khoshfetrat; Seyyede Momeneh Mohammadi; Leonardo Cordeiro de Souza; Ata Mahmoodpoor

doi:10.3389/fmed.2022.830974

New integrated weaning indices from mechanical ventilation: A derivation-validation observational multicenter study

Front Med (Lausanne). 2022 Jul 22:9:830974. doi: 10.3389/fmed.2022.830974. eCollection 2022.

Authors

Amir Vahedian-Azimi¹, Keivan Gohari-Moghadam², Farshid Rahimi-Bashar³, Abbas Samim⁴, Masoum Khoshfetrat⁵, Seyyede Momeneh Mohammadi⁶, Leonardo Cordeiro de Souza⁷, Ata Mahmoodpoor⁸

Affiliations

¹ Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
² Medical ICU and Pulmonary Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
³ Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran.
⁴ Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
⁵ Department of Anesthesiology and Critical Care, Khatamolanbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
⁶ Department of Anatomical Sciences, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
⁷ Physical Therapy College, Universidade Estáciode Sá, Rio de Janeiro, Brazil.
⁸ Evidence Based Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Abstract

Background: To develop ten new integrated weaning indices that can predict the weaning outcome better than the traditional indices.

Methods: This retrospective-prospective derivation-validation observational multicenter clinical trial (Clinical Trial.Gov, NCT01779297), was conducted on 1,175 adult patients admitted at 9 academic affiliated intensive care units (ICUs; 4 surgical and 5 medical), from Jan 2013 to Dec 2018. All patients, intubated and mechanically ventilated for at least 24 h and ready for weaning were enrolled. The study had two phases: at first, the threshold values of each index that best discriminate between a successful and an unsuccessful weaning outcome was determined among 208 patients in the derivation group. In the second phase, the predictive performance of these values was prospectively tested in 967 patients in the validation group. In the prospective-validation set we used Bayes' theorem to assess the probability of each test in predicting weaning.

Results: In the prospective validation group, sensitivity, specificity, diagnostic accuracy, positive and negative predictive values, and finally area under the receiver operator characteristic curves and standard errors for each index (ten formulae) were calculated. Statistical values of ten formulae for aforesaid variables were higher than 87% (0.87-0.99).

Conclusion: The new indices can be used for hospitalized patients in intensive care settings for accurate prediction of the weaning outcome.

Keywords: cut-off values; likelihood ratio; mechanical ventilation; receiver-operating characteristic curve; weaning indices.