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Colegio de Medicina Interna de México.

2015, Number 2

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Med Int Mex 2015; 31 (2)

Usefulness of CROP index as prognosis marker of successful extubation

Montaño-Alonso EA, Jiménez-Saab NG, Vargas-Ayala G, García-Sánchez JL, Rubio-Sánchez ME, Reyna-Ramírez MJ, Ledesma-Velázquez A

Language: Spanish
References: 31
Page: 164-173
PDF size: 552.24 Kb.


ABSTRACT

Background: Mechanical ventilation (MV) is the basis of supportive treatment of acute respiratory failure. However, the perpetuation of ventilatory support beyond what is necessary can mean a greater chance of nosocomial infection, respiratory muscle atrophy and increased hospital stay and costs. Thus, the fan-off maneuver, conducted by testing spontaneous ventilation (TSV) must be designed appropriately and early in the evolution of a patient connected to VM. However, the failure of extubation also has a significant morbidity and mortality, and there are currently no suitable parameters to predict its success or failure. The CROP index in prospective cohort study found that a score of 13 mL/breath/min predicted successful weaning with positive and negative predictive values of 71% and 70%, respectively, in a population with a success rate of weaning of about 60%, which dates from 1991, without since then having any more studies, or reports of this index in the Mexican population taken.
Objective: To assess the effectiveness of the CROP index as a prognostic indicator for removal of mechanical ventilatory support.
Material and method: An observational, comparative, longitudinal and prolective cohort. A sample was determined of patients (men and women) under mechanical ventilatory support, in protocol withdrawal of ventilation. Initial measurements were taken to calculate CROP index, index Tobin and MIP, with a subsequent measurement at 48 hours to determine the success or failure of the extubation process. Univariate statistics were used to determine the association of the CROP index greater than 13 and the successful extubation as dichotomous qualitative variables using the X2 test. This association was also evaluated by the value of the relative risk (Hazard ratio, RR).
Results: Sixty-five patients were included in the recall protocol of invasive mechanical ventilation, of whom 55.3% were women. Association with the CROP index › 13 and successful extubation was determined by finding a X2=23.4, with a p value ‹0.001. This association was also evaluated by the value of the finding that the relative risk CROP index › 13 has an RR = 3.01 for successful extubation, with a confidence interval of 95% from 1.59 to 5.67.
Conclusions: The CROP index above 13 (as recommended by the weaning protocol) was statistically significantly associated with successful extubation, proving to be superior even to other predictors of successful extubation.


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