Thenar oxygen saturation (StO(2)) alterations during a spontaneous breathing trial predict extubation failure

Background Weaning from mechanical ventilation (MV) is a cardiovascular stress test. Monitoring the regional oxygenation status has shown promising results in predicting the tolerance to spontaneously breathe in the process of weaning from MV. Our aim was to determine whether changes in skeletal mus...

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Autores: Mesquida, J, Gruartmoner, G, Espinal, C, Masip, J, Sabatier, C, Villagra, A, Gomez, H, Pinsky, M, Baigorri, F, Artigas, A
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Institución:Institut d'Investigació i Innovació Parc Taulí (I3PT)
Repositorio:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
OAI Identifier:oai:i3pt.fundanetsuite.com:p2640
Acceso en línea:https://i3pt.portalinvestigacion.com/publicaciones/2640
Access Level:acceso abierto
Palabra clave:Near-infrared spectroscopy
Tissue oxygenation
Microcirculation
Regional blood flow
Mechanical ventilation
Weaning
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spelling Thenar oxygen saturation (StO(2)) alterations during a spontaneous breathing trial predict extubation failureMesquida, JGruartmoner, GEspinal, CMasip, JSabatier, CVillagra, AGomez, HPinsky, MBaigorri, FArtigas, ANear-infrared spectroscopyTissue oxygenationMicrocirculationRegional blood flowMechanical ventilationWeaningBackground Weaning from mechanical ventilation (MV) is a cardiovascular stress test. Monitoring the regional oxygenation status has shown promising results in predicting the tolerance to spontaneously breathe in the process of weaning from MV. Our aim was to determine whether changes in skeletal muscle oxygen saturation (StO(2)) measured by near-infrared spectroscopy (NIRS) on the thenar eminence during a vascular occlusion test (VOT) can be used to predict extubation failure from mechanical ventilation. Methods We prospectively studied 206 adult patients with acute respiratory failure receiving MV for at least 48 h from a 30-bed mixed ICU, who were deemed ready to wean by their physicians. Patients underwent a 30-min spontaneous breathing trial (SBT), and were extubated according to the local protocol. Continuous StO(2) was measured non-invasively on the thenar eminence. A VOT was performed prior to and at 30 min of the SBT (SBT30). The rate of StO(2) deoxygenation (DeO(2)), StO(2) reoxygenation (ReO2) rate and StO(2) hyperemic response to ischemia (H-AUC) were calculated. Results Thirty-six of the 206 patients (17%) failed their SBT. The remainder 170 patients (83%) were extubated. Twenty-three of these patients (13.5%) needed reinstitution of MV within 24 h. Reintubated patients displayed a lower H-AUC at baseline, and higher relative changes in their StO(2) deoxygenation rate between baseline and SBT30 (DeO(2) Ratio). A logistic regression-derived StO(2) score, combining baseline StO(2), H-AUC and DeO(2) ratio, showed an AUC of 0.84 (95% CI 0.74-0.91) for prediction of extubation failure. Conclusions Extubation failure was associated to baseline and dynamic StO(2) alterations during the SBT. Monitoring StO(2)-derived parameters might be useful in predicting extubation outcome.ELSEVIER2020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://i3pt.portalinvestigacion.com/publicaciones/2640Annals of Intensive CareISSN: 21105820reponame:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulíinstname:Institut d'Investigació i Innovació Parc Taulí (I3PT)Inglésinfo:eu-repo/semantics/openAccessoai:i3pt.fundanetsuite.com:p26402026-06-21T15:30:37Z
dc.title.none.fl_str_mv Thenar oxygen saturation (StO(2)) alterations during a spontaneous breathing trial predict extubation failure
title Thenar oxygen saturation (StO(2)) alterations during a spontaneous breathing trial predict extubation failure
spellingShingle Thenar oxygen saturation (StO(2)) alterations during a spontaneous breathing trial predict extubation failure
Mesquida, J
Near-infrared spectroscopy
Tissue oxygenation
Microcirculation
Regional blood flow
Mechanical ventilation
Weaning
title_short Thenar oxygen saturation (StO(2)) alterations during a spontaneous breathing trial predict extubation failure
title_full Thenar oxygen saturation (StO(2)) alterations during a spontaneous breathing trial predict extubation failure
title_fullStr Thenar oxygen saturation (StO(2)) alterations during a spontaneous breathing trial predict extubation failure
title_full_unstemmed Thenar oxygen saturation (StO(2)) alterations during a spontaneous breathing trial predict extubation failure
title_sort Thenar oxygen saturation (StO(2)) alterations during a spontaneous breathing trial predict extubation failure
dc.creator.none.fl_str_mv Mesquida, J
Gruartmoner, G
Espinal, C
Masip, J
Sabatier, C
Villagra, A
Gomez, H
Pinsky, M
Baigorri, F
Artigas, A
author Mesquida, J
author_facet Mesquida, J
Gruartmoner, G
Espinal, C
Masip, J
Sabatier, C
Villagra, A
Gomez, H
Pinsky, M
Baigorri, F
Artigas, A
author_role author
author2 Gruartmoner, G
Espinal, C
Masip, J
Sabatier, C
Villagra, A
Gomez, H
Pinsky, M
Baigorri, F
Artigas, A
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Near-infrared spectroscopy
Tissue oxygenation
Microcirculation
Regional blood flow
Mechanical ventilation
Weaning
topic Near-infrared spectroscopy
Tissue oxygenation
Microcirculation
Regional blood flow
Mechanical ventilation
Weaning
description Background Weaning from mechanical ventilation (MV) is a cardiovascular stress test. Monitoring the regional oxygenation status has shown promising results in predicting the tolerance to spontaneously breathe in the process of weaning from MV. Our aim was to determine whether changes in skeletal muscle oxygen saturation (StO(2)) measured by near-infrared spectroscopy (NIRS) on the thenar eminence during a vascular occlusion test (VOT) can be used to predict extubation failure from mechanical ventilation. Methods We prospectively studied 206 adult patients with acute respiratory failure receiving MV for at least 48 h from a 30-bed mixed ICU, who were deemed ready to wean by their physicians. Patients underwent a 30-min spontaneous breathing trial (SBT), and were extubated according to the local protocol. Continuous StO(2) was measured non-invasively on the thenar eminence. A VOT was performed prior to and at 30 min of the SBT (SBT30). The rate of StO(2) deoxygenation (DeO(2)), StO(2) reoxygenation (ReO2) rate and StO(2) hyperemic response to ischemia (H-AUC) were calculated. Results Thirty-six of the 206 patients (17%) failed their SBT. The remainder 170 patients (83%) were extubated. Twenty-three of these patients (13.5%) needed reinstitution of MV within 24 h. Reintubated patients displayed a lower H-AUC at baseline, and higher relative changes in their StO(2) deoxygenation rate between baseline and SBT30 (DeO(2) Ratio). A logistic regression-derived StO(2) score, combining baseline StO(2), H-AUC and DeO(2) ratio, showed an AUC of 0.84 (95% CI 0.74-0.91) for prediction of extubation failure. Conclusions Extubation failure was associated to baseline and dynamic StO(2) alterations during the SBT. Monitoring StO(2)-derived parameters might be useful in predicting extubation outcome.
publishDate 2020
dc.date.none.fl_str_mv 2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://i3pt.portalinvestigacion.com/publicaciones/2640
url https://i3pt.portalinvestigacion.com/publicaciones/2640
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv ELSEVIER
publisher.none.fl_str_mv ELSEVIER
dc.source.none.fl_str_mv Annals of Intensive Care
ISSN: 21105820
reponame:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
instname:Institut d'Investigació i Innovació Parc Taulí (I3PT)
instname_str Institut d'Investigació i Innovació Parc Taulí (I3PT)
reponame_str r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
collection r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
repository.name.fl_str_mv
repository.mail.fl_str_mv
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