Clinical study on the predictive value of dynamic energy expenditure monitoring to guide the weaning from mechanical ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

QIAN Yajun , LIU Yang , HAO Yingying , CHEN Ming , GU Qin ,  DONG Danjiang

Department of Intensive Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210009, P. R. China;

Corresponding?author：

DONG Danjiang, Email: dongdanjiang@sina.com

Keywords：

Energy expenditure; Mechanical ventilation; Weaning; Rapid shallow breath index

DOI：

10.7507/1671-6205.202004041

Video：

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Objective To compare the predictive values of dynamic energy expenditure (EE) monitoring and the traditional method (rapid shallow breath index) for weaning in patient who is suitable for weaning from mechanical ventilation and accepts sequentially reduced support of ventilator.Methods This study included a total of 93 patients who were admitted to the Department of Intensive Care Medicine in 2018 to 2019, and were eligible for weaning from mechanical ventilation. The energy expenditure monitoring device of GE ventilator (CARESCAPE R860) was used to record the patient's change rate of EE [δEE(%), T1 (PSV 20/5), T2 (PSV 15/5), T3 (PSV 10-5/5), T4 (PSV 5/5)] while the ventilation support was declined. The differences in δEE were compared between the two groups of patients who were successful weaned (a successful group S) or failed (a failed group) at different phases. The receiver operator characteristic (ROC) curve was used to analyze the predictive value of δEE to the success rate of weaning.Result A total of 36 patients failed weaning procedure. There was no significant difference in the basic status and disease type between the successful group and the failed group. There was no difference in δEE₁ between T1-T2 phases [(5.67±2.31)% vs. (6.40±1.90)%, P>0.05], but significant difference in δEE between T2-T3 and T3-T4 phases [δEE₂: (11.35±5.39)% vs. (14.21±6.33)%, P<0.05; δEE₃: (8.39±3.90)% vs. (17.32±9.07)%, P<0.05]. The area under the ROC curve predicted by δEE₂ and δEE₃ for the patient's weaning results was higher than rapid shallow breath index (0.83 and 0.75 vs. 0.64, P<0.05).Conclusion Dynamic energy expenditure monitoring can effectively evaluate and predict the success rate of weaning from mechanical ventilation, and can be applied to the clinical treatment process.

Citation： QIAN Yajun, LIU Yang, HAO Yingying, CHEN Ming, GU Qin, DONG Danjiang. Clinical study on the predictive value of dynamic energy expenditure monitoring to guide the weaning from mechanical ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(5): 325-329. doi: 10.7507/1671-6205.202004041 Copy

1.	Dehghani A, Abdeyazdan G, Davaridolatabadi E. An overview of the predictor standard tools for patient weaning from mechanical ventilation. Electron Physician, 2016, 8(2): 1955-1963.
2.	Segadilha NLAL, Rocha EEM, Tanaka LMS, et al. Energy expenditure in critically ill elderly patients: indirect calorimetry vs predictive equations. JPEN J Parenter Enteral Nutr, 2017, 41(5): 776-784.
3.	王麗娟, 趙蘭菊, 楊小娟, 等. 間接測熱法與 HB 公式法測定多發傷機械通氣患者能量消耗的一致性研究. 中華危重病急救醫學, 2018, 30(10): 946-949.
4.	Swinamer DL, Grace MG, Hamilton SM, et al. Predictive equation for assessing energy expenditure in mechanically ventilated critically ill patients. Crit Care Med, 1990, 18(6): 657-661.
5.	林寧, 黃秋霞, 張慧珍, 等. 膈肌超聲在機械通氣患者撤機中的應用. 中國呼吸與危重監護雜志, 2019, 18(4): 339-343.
6.	Esteban A, Anzueto A, Frutos F, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA, 2002, 287(3): 345-355.
7.	陳文秀, 穆心葦. 超聲在機械通氣患者撤機過程中的應用現狀. 中華危重癥醫學雜志(電子版), 2017, 10(4): 274-278.
8.	Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure--a structured approach. Crit Care, 2010, 14(6): 245.
9.	Karthika M, Al Enezi FA, Pillai LV, et al. Rapid shallow breathing index. Ann Thorac Med, 2016, 11(3): 167-176.
10.	Lee KH, Hui KP, Chan TB, et al. Rapid shallow breathing (frequency-tidal volume ratio) did not predict extubation outcome. Chest, 1994, 105(2): 540-543.
11.	Huang CT, Yu CJ. Conventional weaning parameters do not predict extubation outcome in intubated subjects requiring prolonged mechanical ventilation. Respir Care, 2013, 58(8): 1307-1314.
12.	馬玉杰, 曹相原. 淺快呼吸指數的變化趨勢在機械通氣撤離中的預測價值. 中國呼吸與危重監護雜志, 2010, 9(6): 567-569.
13.	Boniatti VM, Boniatti MM, Andrade CF, et al. The modified integrative weaning index as a predictor of extubation failure. Respir Care, 2014, 59(7): 1042-1047.
14.	Takken T, Stephens S, Balemans A, et al. Validation of the Actiheart activity monitor for measurement of activity energy expenditure in children and adolescents with chronic disease. Eur J Clin Nutr, 2010, 64(12): 1494-1500.
15.	Reid CL. Nutritional requirements of surgical and critically-ill patients: do we really know what they need?. Proc Nutr Soc, 2004, 63(3): 467-472.
16.	Oshima T, Berger MM, De Waele E, et al. Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group. Clin Nutr, 2017, 36(3): 651-662.
17.	Martin AD, Smith BK, Davenport PD, et al. Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial. Crit Care, 2011, 15(2): R84.
18.	石俊, 席力罡, 遲天航, 等. 靜息能量監測在機械通氣患者營養支持治療中的應用價值. 中華危重病急救醫學, 2019, 31(1): 98-101.

1. Dehghani A, Abdeyazdan G, Davaridolatabadi E. An overview of the predictor standard tools for patient weaning from mechanical ventilation. Electron Physician, 2016, 8(2): 1955-1963.
2. Segadilha NLAL, Rocha EEM, Tanaka LMS, et al. Energy expenditure in critically ill elderly patients: indirect calorimetry vs predictive equations. JPEN J Parenter Enteral Nutr, 2017, 41(5): 776-784.
3. 王麗娟, 趙蘭菊, 楊小娟, 等. 間接測熱法與 HB 公式法測定多發傷機械通氣患者能量消耗的一致性研究. 中華危重病急救醫學, 2018, 30(10): 946-949.
4. Swinamer DL, Grace MG, Hamilton SM, et al. Predictive equation for assessing energy expenditure in mechanically ventilated critically ill patients. Crit Care Med, 1990, 18(6): 657-661.
5. 林寧, 黃秋霞, 張慧珍, 等. 膈肌超聲在機械通氣患者撤機中的應用. 中國呼吸與危重監護雜志, 2019, 18(4): 339-343.
6. Esteban A, Anzueto A, Frutos F, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA, 2002, 287(3): 345-355.
7. 陳文秀, 穆心葦. 超聲在機械通氣患者撤機過程中的應用現狀. 中華危重癥醫學雜志(電子版), 2017, 10(4): 274-278.
8. Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure--a structured approach. Crit Care, 2010, 14(6): 245.
9. Karthika M, Al Enezi FA, Pillai LV, et al. Rapid shallow breathing index. Ann Thorac Med, 2016, 11(3): 167-176.
10. Lee KH, Hui KP, Chan TB, et al. Rapid shallow breathing (frequency-tidal volume ratio) did not predict extubation outcome. Chest, 1994, 105(2): 540-543.
11. Huang CT, Yu CJ. Conventional weaning parameters do not predict extubation outcome in intubated subjects requiring prolonged mechanical ventilation. Respir Care, 2013, 58(8): 1307-1314.
12. 馬玉杰, 曹相原. 淺快呼吸指數的變化趨勢在機械通氣撤離中的預測價值. 中國呼吸與危重監護雜志, 2010, 9(6): 567-569.
13. Boniatti VM, Boniatti MM, Andrade CF, et al. The modified integrative weaning index as a predictor of extubation failure. Respir Care, 2014, 59(7): 1042-1047.
14. Takken T, Stephens S, Balemans A, et al. Validation of the Actiheart activity monitor for measurement of activity energy expenditure in children and adolescents with chronic disease. Eur J Clin Nutr, 2010, 64(12): 1494-1500.
15. Reid CL. Nutritional requirements of surgical and critically-ill patients: do we really know what they need?. Proc Nutr Soc, 2004, 63(3): 467-472.
16. Oshima T, Berger MM, De Waele E, et al. Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group. Clin Nutr, 2017, 36(3): 651-662.
17. Martin AD, Smith BK, Davenport PD, et al. Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial. Crit Care, 2011, 15(2): R84.
18. 石俊, 席力罡, 遲天航, 等. 靜息能量監測在機械通氣患者營養支持治療中的應用價值. 中華危重病急救醫學, 2019, 31(1): 98-101.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical study on the predictive value of dynamic energy expenditure monitoring to guide the weaning from mechanical ventilation

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