Journal des soins intensifs et critiques Libre accès

Abstrait

Triple Testing as a Tool to Detect NonReintubation in Weaning from Mechanical Ventilation in Critically Ill Patients from the Intensive Care Unit, IPSU, Medellin, Colombia- Cross Sectional and Diagnostic Research Study

Valencia E, Avendaño A, Marrugo A, Bustamante C , Camacho LA, Figueroa J, Hernandez A, Valencia G, Patiño D, La Verde DC, Garcés GA, Vásquez AM, Córdoba Y, Arias Y, Duque N, Correa B, Marín PA, Rojas P, Gomez J, Chalarca JP, Suarez C, Arias D, Rendon J, Bedoya H, Arevalo C, Ramirez J, Sarmiento A, Jimenez E, Vasquez L

Introduction: Weaning from mechanical ventilation still consumes many medical efforts. In addition to the numerical parameters in mechanical ventilation weaning decisions, some clinical decisions must be explored in more depth. The clinical extubation score should be combined with the spontaneous breathing test protocol and the superficial respiration index. This "triple test" should be utilised in daily clinical work.

Objective: Predict NON-reintubation based on combining the clinical extubation score (NRS), to the spontaneous ventilation test (SBT), and the superficial respiration index (IRS).

Materials & Methods: A prevalence research study and diagnostic tests were carried out. Measurements: The study is the demonstration of the "triple test" (TT) (Valencia, 2010) for the extubation of critically ill intubated patients. The study was carried out in the intensive care unit of IPS Universitaria between 2018 and 2019. For the clinical demonstration, 1,170 critically ill patients with the most common pathologies found in our city were used. This included those with: septic shock, community-acquired pneumonia, decompensated emphysema, secondary peritonitis, postoperative heart surgery and postoperative brain tumor resection surgery. Statistics: For the measurements, a sensitivity and specificity calculations analysis was performed with a statistical program of SPSS-25.

Results: One thousand one hundred and seventy patients were studied (1,170). 666 (56.9%) were men and 504 (43%) were women. The average age was 61.06 + 17.2 years. Score obtained from MPM-II: 43.59 + 25.9. The overall mortality rate of the patients intubated in the intensive care unit was 36.1% and the mortality rate of the reintubated patients was 36.3%. Mortality associated with the use of mechanical ventilation was a third higher than the overall mortality rate (24.1%). The prevalence of reintubation was 5.73% with the use of the “triple test”. The triple test in the extubation of critically ill patients showed a sensitivity of 1.49% (0.08-9.14%); specificity of 99.9% (99.4%-100%); with a positive predictive value (PPV) of 50% (2.67%-97.3%) and a Negative Predictive Value (NPV) of 94.3% (92.8%-95.57%), with a positive probability ratio (CPP) of 16.4 (1.04-260.3) and a negative probability ratio (CPN) of 0.99 (0.96-1.02).

Conclusion: The spontaneous ventilation test combined with the superficial respiration index <55 and the release score interpreted in the form of a serial statistical test, the "triple test”, is an effective tool for identifying patients who can be safely extubated, with a very low risk of reintubation. In addition, the high specificity and high negative probability ratio make it easier to determine who is NOT reintubatable among the intubates. The combination of tests is not carried out with the aim of detecting candidate patients to extubate. The increase in specificity created by combining the three criteria, in relation to the need to reintubate, allows the decision to extubate to be safer. Traditional extubation of mechanical ventilation, based on only one parameter, does not seem to be justified.