Using twitch tracheal airway pressure, negative inhale forced pressure, and Medical Research Council score to guide weaning from mechanical ventilation.

Abstract

Weaning from mechanical ventilation (MV) is an important and universal issue in critically ill patients, with no consensus that predicts weaning success. Twitch tracheal airway pressure (TwPtr) may be a more objective indicator of diaphragm function. The present study evaluated TwPtr relative to negative inspiratory force (NIF) or Medical Research Council (MRC) score, for predicting success of weaning from MV. From December 2015 to March 2017, 62 patients were included who received invasive MV >48 hours and then underwent a test for spontaneous breathing. The NIF and MRC score were sequentially determined. The TwPtr measurement was performed via magnetic stimulation of the neck phrenic nerve. Weaning success was achieved by 54 patients (87.1%), including 30, 12, and 12 patients who experienced simple, difficult, and prolonged weaning, respectively. The areas under receiver operating characteristic curves (AUCs) for NIF, MRC score, and TwPtr were 0.778, 0.560, and 0.792. When TwPtr was combined with NIF, the sensitivity and specificity of weaning success were 96.3% and 75.0%, and AUC was 0.807. In the weaning success group, after correction for age, the AUC of TwPtr was 0.878, which differentiated the simple weaning from non-simple group. TwPtr was superior to either NIF or MRC score for differentiating patients in the simple weaning group from those patients who experienced difficult, prolonged, or failed weaning. TwPtr combined with NIF may be used to predict weaning success better than the MRC score alone.