Utility of OMAHA+ Scale in the Successful Weaning From Ventilator

Abstract

SESSION TITLE: Mechanical Ventilation & Respiratory Failure II SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Currently there is not an ideal weaning index, this should include: assessment of the pathophysiological determinants of weaning outcome, including ventilatory muscle function, pulmonary gas exchange (ventilation and oxygenation), and psychological problems, accurately evaluate physiological function, ease of measurement and reproducible measurements, minimum patient cooperation, and high positive and negative predictive values. The aim of this study was to describe the clinical outcomes of extubation process in patients hospitalized at ICU using the OMAHA+ scale, which refers to Oxigenation, respiratory Mechanics, Acid-base status, Hemodynamics and Airway, plus directed physical examination. METHODS: We conducted a descriptive, prospective study, based on the record of the instrument OMAHA+ and follow up of 190 patients during and after extubation in both adult intensive care units in the Universitary Hospital of Fundación Santa Fe de Bogotá August 2014 and February 2016. RESULTS: Mean age was 63 years old and mean weight 68 kilograms, 57% were male, OMAHA+ scale was applied to 100% of patients in the sample, oxygenation impairment was mild (mean PaO2/FiO2 index 256 mmHg, SD±65 mmHg), however when adjusted by altitude correction factor PaO2/FiO2 corresponds to 180 mmHg at height of Bogotá, mean Rapid Shallow Breathing Index was low (36.7 SD± 14.3), vital signs were close to normal values (arterial oxygen saturation higher than 90% was 98%; mean respiratory rate 18 per minute; mean systolic arterial blood pressure 126 mmHg and mean heart rate was 93 beats per minute). Tidal volume in spontaneous effort higher than 0.5 liters was found in 98.7%, vital capacity ≥ 10 milliliters was 90%, maximum inspiratory pressure higher than 20 mmHg was 96%, positive cuff-leak test was 94.8%, effective cough 98.8%, tracheobronchial secretions were present just in 11% of patients after extubation, conscientious level was adequate in 96% of cases, extubation failure was present only in 1.58%, mean ventilation days was 3.6 (range 1 to 25 days), and mean ICU length of stay was 13 days. CONCLUSIONS: OMAHA+ aims to bring together the variables of an ideal index ventilatory weaning. Present data provide results indicating a low rate of extubation failure without increasing the days of mechanical ventilation. CLINICAL IMPLICATIONS: Higher succesful extubation rates could be possible applying this integrated but simple scale, with shorter length of stay at the ICU and less costs. DISCLOSURE: The following authors have nothing to disclose: Natalia Garzón Posada, Jorge Carrizosa, David Rodriguez, Salvador Menéndez, Edgar Celis, Leopoldo Ferrer No Product/Research Disclosure Information