Abstract
Background:Weaning from mechanical ventilation is a key element in the care of critically ill patients, and Spontaneous Breathing Trial (SBT) is a crucial step in this procedure. This nested case-control study aimed to evaluate whether central oxygen saturation (ScvO2) values and their changes could independently predict the SBT outcome among mechanically ventilated patients.Methods: A prospective cohort of patients who were mechanically ventilated for at least 48hours and fulfilled the criteria of readiness to wean constituted the study population. All patients attempted a SBT and were then categorized in SBT success group and SBT failure group, based on a combination of criteria which indicated whether SBT was successful or not. Multivariate binary logistic regression analysis was utilized to indicate the independent predictors of SBT success, while the Receiver Operating Characteristic (ROC) curves were used to demonstrate the diagnostic accuracy of these independent predictors.Results:Seventy-seven patients 69(18-86) years old; 62.3% male) constituted the study population. SBT was successful among 63.6% of them. A decrease in ScvO2 values (ΔScvO2) < 4% between the beginning and the end of the trial independently predicted the successful outcome (OR=18.278; 95% CI=4.017-83.163), along with age, Hemoglobin concentration (Hb) and arterial oxygen saturation (SaO2). Diagnostic accuracy for ΔScvO2 alone (ROC area=0.715) was slightly superior to that of either SaO2 (0.625) or Hb (0.685) to predict SBT success.Conclusion:ScvO2 is an independent predictor of the weaning outcome and its evaluation may further facilitate the accurate categorization among those patients who pass or fail the SBT.
Highlights
Weaning patients from mechanical ventilation are one of the key elements in the course of the treatment of critically ill patients and could represent up to 40% of the time that a patient spends on mechanical ventilation [1, 2]
Mixed venous oxygen saturation (SvO2), which requires invasive measurements via right heart catheterization, and the easier to obtain central venous oxygen saturation (ScvO2), are two indices closely associated with global tissue oxygenation; their routine screening is currently not recommended as part of the evaluation of the Spontaneous Breathing Trial (SBT) outcome
In this prospective, nested case-control study we indicated that ScvO2end is an independent predictor of SBT outcome, with a decrease of ScvO2
Summary
Weaning patients from mechanical ventilation are one of the key elements in the course of the treatment of critically ill patients and could represent up to 40% of the time that a patient spends on mechanical ventilation [1, 2]. SvO2 and ScvO2 measurements have been previously studied in regards to several outcomes and in several patient populations [2, 13, 14], data on the prognostic accuracy of SvO2 values, ScvO2 values and their changes on the weaning outcome, is currently limited [2, 15, 16] Most of these studies were conducted in selected patient populations [2, 15] or aimed to investigate whether ScvO2 and SvO2 could predict the extubation outcome, which is the final and not the initial step of the weaning procedure [2, 16] and could be, influence by several other factors not closely associated with tissue oxygenation, such as an inadequate cough or laryngeal edema [10]. Weaning from mechanical ventilation is a key element in the care of critically ill patients, and Spontaneous Breathing Trial (SBT) is a crucial step in this procedure This nested case-control study aimed to evaluate whether central oxygen saturation (ScvO2) values and their changes could independently predict the SBT outcome among mechanically ventilated patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
