Abstract
Introduction: Weaning from mechanical ventilation and extubation is always challenging in intensive care units and becomes more challenging in obese patients. Commonly used weaning parameters include vital capacity, negative inspiratory force, and rapid shallow breathing index (RSBI) during spontaneous breathing trials(SBT). These parameters help in making decisions for extubation, but extubation failures persist. 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. However, limited data exists on IPI during weaning from mechanical ventilation. IPI of 8 or higher may be associated with successful wean and this study tested the hypothesis that average IPI is higher during successful SBTs than unsuccessful SBTs in obese patients. Methods: This IRB approved, prospective, observational trial was performed on mechanically ventilated patients in the surgical intensive care unit. 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 studied24 obese patients (16 males, 8 females) with BMI > 30, mean age of 57.6 ± 11.5 years, underwent cardiopulmonary bypass surgery. They received total of 37 SBTs. Statistical analysis revealed that median IPI (med: 25%ile-75%ile) was higher in passing (9.06: 8.34–9.12) than failing (7.64: 6.16–8.53) SBTs (p< 0 .005). Conclusions: IPI values are higher in successful SBTs than in failing SBTs in obese patients undergoing evaluation for weaning. Further studies and larger sample size are needed to more clearly define the value of IPI during weaning from mechanical ventilation.
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