Abstract
Approximately 40% of patients admitted to the medical intensive care unit (ICU) require mechanical ventilation. An accurate prediction of successful extubation in patients is a key clinical problem in ICU due to the fact that the successful extubation is highly associated with prolonged ICU stay. The prolonged ICU stay is also associated with increasing cost and mortality rate in healthcare system. This study is retrospective in the aspect of ICU. Hence, a total of 41 patients were selected from the largest academic medical center in Taiwan. Our experimental results show that predicting successful rate of 87.8% is obtained from the proposed predicting function. Based on several types of statistics analysis, including logistic regression analysis, discriminant analysis, and bootstrap method, three major successful extubation predictors, namely, rapid shallow breathing index, respiratory rate, and minute ventilation, are revealed. The prediction of successful extubation function is proposed for patients, ICU, physicians, and hospital for reference.
Highlights
In recent years, human activities, such as burning of fossil fuels and coal, have led to dust-storm, frog, and haze [1]
This study was conducted at the Chang Gung Memorial Hospital (CGMH) in Taiwan that was approved by the Institutional Review Board of the hospital
In order to filter out successful extubation predictors, following weaning protocols, we used the Delphi method with face-to-face interviews and consultation with 8 professional doctors in the department of chest diseases at CGMH, who helped to obtain the most important 9 successful extubation predictors, such as (1) gender; (2) Glasgow Coma Scale (GCS): E, V, and M score; (3) respiratory rate (RR) (f); (4) minute ventilation (MV); (5) maximal inspiratory pressure (PiMax or Maximum inspiratory pressure (MIP)); (6) rapid shallow breathing index (RSBI); (7) arterial blood gas (ABS) and PH; (8) arterial carbon dioxide tension (PaCO2); and (9) partial pressure of oxygen (PaO2)
Summary
Human activities, such as burning of fossil fuels and coal, have led to dust-storm, frog, and haze [1]. Several epidemiological studies have shown the effects of chronic exposure to air pollution (e.g., PM2.5, nitrogen dioxide, and NO2) on lung function [2]. Air pollution is closely related to both the development and exacerbation of pulmonary disease. Approximately 40% of all pulmonary disease patients in medical intensive care unit (ICU) require mechanical ventilation [3, 4]. Many of them are extubated in 2 to 4 days after the start of ventilation, whereas up to 25% require mechanical ventilation for more than 7 days [5]. In spite of weaning protocols, automated systems, daily spontaneous breathing trials, and pressuresupport ventilation, it is estimated that 20–30% of patients cannot be extubated upon the first weaning attempt [6]. In spite of weaning protocols, automated systems, daily spontaneous breathing trials, and pressuresupport ventilation, it is estimated that 20–30% of patients cannot be extubated upon the first weaning attempt [6]. 29%
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