Aguirre RPA, Martínez RKS, Ramírez BC

Language: Spanish
References: 24
Page: 178-185
PDF size: 240.67 Kb.

ABSTRACT

Introduction: the weaning of mechanical ventilation is the objective of the intensivist and even with scientific advances, the prediction of the result is difficult. Authors have demonstrated the effect of delaying the continuation of weaning on mortality and its outcome and the presence of complications due to prolonged MV. The risk of VALI is greater in relation to the time of MV and is proportional to the result obtained in the mechanical monitoring by the established ventilation mode. This presents as a flow-related excess work of breathing. Related to VALI, driving pressure and mechanical power were identified as mathematical methods that include mechanical monitoring variables and determine a value that is directly associated with statistical power for damage identification. Authors correlated PM values with mortality, observing that this, generated by ventilation in spontaneous mode in assist-proportional ventilation in a EVP, had an impact on the successful withdrawal of mechanical ventilation compared to patients who maintained a continuos mandatory mode. However, it was not possible associate the same cohort point as a predictor of weaning success, so it was decided to develop this research and find a possible association of the mechanical power value obtained with de EVP outcome. Objective: to evaluate the mechanical power as a predictor of failure in the weaning of mechanical ventilation in critical patients hospitalized in the intensive care unit of the Centro Médico Nacional de Occidente. Material and methods: a retrospective cohort study was carried out. It was evaluated by the ethics and research committee of the CMNO Hospital de Especialidades. A ROC curve was performed, obtaining a cohort point for the MP variable with the best Youden index and, based on the results of the weaning, they were divided into two groups for analysis. Like success and failure. descriptive statistic were used for qualitative variables. For normality, the Kolmogorov-Smirnov test was used. Sensitivity, specificity and predictive values of mechanical power were calculated. Risk estimate (likelohood ratios and 95% confidence intervals). Statistical significance was established as p < 0.05. Results: we analysed a sample of 63 patients admitted to the ICU of CMNO who met the inclusion criteria, documenting a successful outcome of the MV weaning test in 85.7% (54). We performed a ROC curve, obtaining a cohort point of 8.10 J/min, perform a by Youden index of 0.537, with an AUC of 0.690. Sensitivity of 66.7%, 1-specificity of 13%, confidence interval at 95% of 0.448-0.932 and a statistical significance of 0.069. The MP variable was dichotomized into two subgroups, less than or equal to 8.10 J/min and greater than 8.11 J/min, and a cohort point sensitivity of 87% and a specificity of 66.7% were obtained, with a PPV of 94% and NPV of 46.2%, 33.3% false positives and 12.9% false negatives. With a Fisher exact significance of 0.002. Spearman's correlation p = 0.000. Kolmogorov-Smirnov test of 1.379 and p = 0.045. Conclusions: the predictive power of the average mechanical power is not useful as a predictor of success or failure in weaning from mechanical ventilation.

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