Abstract
Objective
To assess in a group of COPD patients mechanically ventilated for an episode of acute respiratory failure the respiratory mechanics with a simple and non invasive method at the bedside in order to evaluate if these parameters may be predictive of weaning failure or success.
Design
A prospective study.
Setting
Intensive care and intermediate intensive care units.
Patients
23 COPD patients ventilated for acute respiratory failure and studied within 24 hours from intubation.
Methods
Using end-expiratory and end-inspiratory airway occlusion technique, we measured PEEPi, static compliance of the respiratory system (Crs, st) maximum respiratory resistance (Rrsmax) and minimum respiratory resistance (Rrsmin).
Measurements and results
The weaned group (A) and the not weaned group (B) were not different regarding to static PEEPi (group A 8.5±4.0 vs group B 8.9±2.6 cmH2O), to Rrsmax (22.4±5.3 versus 22.2±9.0 cmH2O/l/s) and to Rrsmin (17.6±5.5 versus 17.9±8.0 cmH2O/l/s), while a significant difference (p<0.001) has been found in Cst, rs (62.7±17.5 versus 111.6±18.0 ml/cm H2O). The threshold value of 88.5 ml/cmH2O was identified by discriminant analysis and provided the best separation between the two groups, with a sensitivity of 0.85 and a specificity of 0.87.
Conclusion
Cst, rs measured non invasively in the first 24 h from intubation, provided a good separation between the patients who were successfully weaned and those who failed.
Article PDF
Similar content being viewed by others
References
Gracey DS, Viggiano RW, Naessens JM, Hubmayr RD, Silverstein RD, Koenig GE (1992) Outcomes of patients admitted to a chronic ventilator-dependent unit in an acute-care hospital. Mayo Clin Proc 76:131–136
Rossi A, Gottfried SB, Higgs BD, Zocchi L, Grassino A, Milic-Emili J (1985) Respiratory mechanics in mechanically ventilated patients with respiratory failure. J Appl Physiol 58:1849–1858
Gottfried SB, Rossi A, Higgs BD, Calverley PMA, Zocchi L, Bozic C, Milic-Emili J (1985) Noninvasive determination of respiratory system mechanics during mechanical ventilation for acute respiratory failure. Am Rev Respir Dis 131:414–420
Broseghini C, Brandolese R, Poggi R, Polese G, Manzin E, Milic-Emili J (1988) Respiratory mechanics during the first day of mechanical ventilation in patients with pulmonary edema and chronic airway obstruction. Am Rev Respir Dis 138:355–361
Tobin MJ, Perez W, Guenther SM, Semmes BJ, Mador MJ, Allen SJ, Lodato RF, Dantzker DR (1986) The pattern of breathing during successful and unsuccessful trials of weaning from mechanical ventilation. Am Rev Respir Dis 134:1111–1118
Rossi A, Gottfried SB, Zocchi L, Higgs BD, Lennox S, Calverley PMA, Begin P, Grassino A, Milic-Emily J (1985) Measurement of static compliance of the total respiratory system in patients with acute respiratory failure during mechanical ventilation. Am Rev Respir Dis 131:672–677
Goldstone J, Moxham J (1991) Weaning from mechanical ventilation. Thorax 46:56–62
Yang KL (1993) Inspiratory pressure/maximal inspiratory pressure ratio: a predictive index of weaning outcome. Intensive Care Med 19:204–208
Begin P, Grassino A (1991) Inspiratory muscle dysfunction and chronic hypercapnia in chronic obstructive pulmonary disease. Am Rev Respir Dis 143:905–912
Roussos C (1979) Respiratory muscle fatigue in the hypercapnic patient. Bull Eur Physiopathol Respir 15:117–123
Rochester DF, Martin LL (1985) Respiratory muscle rest. In: Roussos C, Macklem PT (eds) The thorax. Dekker, New York, pp 1303–1328
Sahn SA, Lakshminarayan S (1973) Bedside criteria for discontinuation of mechanical ventilation. Chest 63: 1002–1005
Stetson JB (1970) Introductory essay. Int Anesthesiol Clin 8:767–779
Feeley TW, Hedley-White J (1975) Weaning from controlled ventilation and supplemental oxygen. N Engl J Med 292:303–306
Montgomery AB, Holle RHO, Neagley SR, Pierson DJ, Schoene RB (1991) Prediction of successful ventilator weaning using airway occlusion pressure and hypercapnic challenge. Chest 4:496–499
Yang KL, Tobin MJ (1991) A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 324: 1445–1450
American Thoracic Society (1987) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD). Am Rev Respir Dis 136:225–243
Rubini F, Rampulla C, Nava S (1994) Acute effects of corticosteroids on respiratory mechanics in mechanically ventilated patients with chronic airflow obstruction and acute respiratory failure. Am J Respir Crit Care Med 149: 306–310
Gay C, Rodarte JR, Tayab M, Hubmayr RD (1987) Evaluation of bronchodilator responsiveness in mechanically ventilated patients. Am Rev Respir Dis 136:880–885
Bates JTH, Rossi A, Milic-Emili J (1985) Analysis of the behaviour of the respiratory system with constant inspiratory flow. J Appl Physiol 58: 1840–1848
Behrakis PK, Higgs BD, Baydur A, Zin WA, Milic-Emili J (1983) Respiratory mechanics during halothane anesthesia and anesthesia-paralysis in humans. J Appl Physiol 55:1085–1092
Bernasconi M, Brandolese R, Poggi R, Manzin E, Rossi A (1990) Dose-response effects and time course of effects of inhaled fenoterol on respiratory mechanics and arterial oxygen tension in mechanically ventilated patients with chronic airflow obstruction. Intensive Care Med 16:108–114
Kochi T, Okubo S, Zin Wa, Milic-Emili J (1988) Flow and volume dependence of pulmonary mechanics in anesthetized cats. J Appl Physiol 64:441–450
Rochester DF (1988) Tests of respiratory muscle functions. Clin Chest Med 9:249–261
Griner PF, Mayewski RJ, Mushlin AI, Greenland P (1981) Selection and interpretation of diagnostic tests and procedures: principles and applications. Ann Intern Med 94:553–600
Morganroth MI, Morganroth JL, Nett LM (1984) Criteria for weaning from prolonged mechanical ventilation. Arch Intern Med 144:1012–1016
Indihar FJ (1991) A 10-year report of patients in a prolonged respiratory care unit. Minn Med 74:23–27
Sassoon CHS, Mahutte CK, Te TT, Simmons DH, Light RW (1987) Airway occlusion pressure. An important indicator for successful weaning in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 135: 107–113
Murciano D, Boczkowski J, Lecocguic Y, Milic-Emili J, Pariente R, Aubier M (1988) Tracheal occlusion pressure: a simple index to monitor respiratory muscles fatigue during acute respiratory failure in patients with chronic obstructive pulmonary disease. Ann Intern Med 108:800–805
Grassino A, Macklem PT (1984) Respiratory muscle fatigue and ventilatory failure. Annu Rev Med 35:625–647
Milic-Emili J (1986) Is weaning an art or a science? Am Rev Respir Dis 134:1107–1108
Pengelly LD, Alderson AM, Milic-Emili J (1971) Mechanics of the diaphragm. J Appl Physiol 30:797–805
Tantucci C, Corbeil C, Chasse M, Braidy J, Matar N, Milic-Emili J (1991) Flow resistance in patients with chronic obstructive pulmonary disease in acute respiratory failure. Am Rev Respir Dis 144:384–389
Gattinoni L, Pesenti A, Caspani ML, Pelizzola A, Mascheroni D, Marcolin R, Iapichino G, Langer M, Agostoni A, Kolobow T, Melrose DG, Damia G (1984) The role of static lung compliance in the management of severe ARDS unresponsive to conventional treatment. Intensive Care Med 10: 121–126
Mancebo J, Benito S, Martin M, Net A (1988) Value of static pulmonary compliance in predicting mortality in patients with acute respiratory failure. Intensive Care Med 14:110–114
D'Angelo E, Calderini E, Torri G, Robatto FM, Bono D, Milic-Emili J (1989) Respiratory mechanics in anesthetized paralyzed humans: effects of flow, volume, and time. J Appl Physiol 67:2556–2564
Benito S, Lemaire F, Mankikian B, Harf A (1985) Total respiratory compliance as a function of lung volume in patients with mechanical ventilation. Intensive Care Med 11:76–79
Bergin C, Mueller N, Nichols DM, Lillington G, Hogg JC, Mullen B, Grymaloski MR, Osborne S, Pare P (1986) The diagnosis of emphysema. A computed tomographic-pathologic correlation. Am Rev Respir Dis 133: 541–546
Sharp JT, van Lith P, Nuchprayoon CV, Briney R, Johnson FN (1968) The thorax in chronic obstructive lung disease. Am J Med 44:39–46
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Zanotti, E., Rubini, F., Iotti, G. et al. Elevated static compliance of the total respiratory system: Early predictor of weaning unsuccess in severe COPD patients mechanically ventilated. Intensive Care Med 21, 399–405 (1995). https://doi.org/10.1007/BF01707408
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01707408