Pendelluft as a predictor of weaning in critically ill patients: An observational cohort study

Danqiong Wang; Yaxin Ning; Linya He; Keqi Pan; Xiaohua Xiong; Shanshan Jing; Jianhua Hu; Jian Luo; Dehua Ye; Zubing Mei; Weiwen Zhang

doi:10.3389/fphys.2023.1113379

Pendelluft as a predictor of weaning in critically ill patients: An observational cohort study

Front Physiol. 2023 Mar 31:14:1113379. doi: 10.3389/fphys.2023.1113379. eCollection 2023.

Authors

Danqiong Wang^{1

2}, Yaxin Ning^{1

2}, Linya He^{1

2}, Keqi Pan^{1

3}, Xiaohua Xiong¹, Shanshan Jing¹, Jianhua Hu¹, Jian Luo¹, Dehua Ye⁴, Zubing Mei^{5

6}, Weiwen Zhang¹

Affiliations

¹ Department of Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China.
² The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
³ School of Medicine, Shaoxing University, Shaoxing, China.
⁴ Institute of Teacher Education, Department of Mathematics and Physics, Quzhou University, Quzhou, China.
⁵ Department of Anorectal Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
⁶ Anorectal Disease Institute of Shuguang Hospital, Shanghai, China.

Abstract

Objective: Weaning failure is associated with adverse clinical outcomes. This study aimed to evaluate the accuracy of pendelluft during the spontaneous breathing trials (SBT) as a predictor of weaning outcome of patients with mechanical ventilation. Methods: An observational cohort study included 60 critically ill patients who were eligible for extubation. Pendelluft and electrical activity of the diaphragm (Edi) were monitored at baseline and every 10 minutes for the first 30 min of SBT denoted as T0, T1, T2, and T3. The pendelluft was measured using electrical impedance tomography (EIT), and Edi parameters were collected by Edi catheter. Patients were followed up after extubation and were divided into success group and failure group. Pendelluft, Edi parameters, respiratory parameters, and clinical outcomes such as intensive care units (ICU) stay, mortality, and 28-day ventilator-free days were compared between the two groups. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of pendelluft to predict weaning outcome. Results: Fifty patients (50/60) were successfully weaned from the machine and 10 (10/60) failed, with weaning failure rate of 16.7%. Respiratory parameters such as rapid shallow breathing index (RSBI), respiratory rate (RR) and Edi parameters such as maximum value of Edi (Edimax), Edi variation between a maximum and minimum(ΔEdi) in the failure group were higher than those in the success group. The ICU stay and the 28-day ventilator-free days in the failure group were significantly longer than those in the success group. The 28-day mortality rate was higher in the failure group. The pendelluft mainly occurred in the early stage of SBT. Ventral pendelluft and total pendelluft in the failure group were higher than those in the success group at T1. Edimax and ΔEdi were positively correlated with pendelluft. The area under ROC curve (AUC) showed moderate predictive ability for ventral pendelluft in predicting weaning failure at T1 (AUC 0.76, 95% CI 0.58-0.94, cut-off value > 3% global tidal variation). Conclusion: Pendelluft is one of the factors leading to weaning failure, which may be related to diaphragm function. Measuring pendelluft volume maybe helpful to predict weaning.

Keywords: electrical impedance tomography; mechanical ventilation; pendelluft; predict; weaning.

Grants and funding

This study was supported by Project of Science and Technology Department of Zhejiang (LGF19H150002), Medical and Health Science and Technology Project of Zhejiang Province (2023KY1295) and High Level Talents Project of Zhejiang.