Volume 17, Issue 1 (4-2020)                   J Res Dev Nurs Midw 2020, 17(1): 1-11 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Mirzaali J, Vakili M, Khoddam H. The Value of Persian Weaning Tool in Prediction of Patients’ Weaning Outcome Compared with Physician- Directed Approach: A Diagnostic Accuracy Study. J Res Dev Nurs Midw. 2020; 17 (1) :1-11
URL: http://nmj.goums.ac.ir/article-1-1181-en.html
1- School of nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran.
2- Department of Biostatistics, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
3- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran. , Khoddam@Goums.ac.ir
Abstract:   (1251 Views)
Background: One of the important criteria in patients receiving artificial respiration is the time of weaning from the mechanical ventilator. As physician’s decision might be somehow subjective, several tools have been suggested for prediction of the time of weaning more objectively. This study aimed to determine the predictive value of Persian Weaning Tool (PWT) compared with Physician- directed approach as the gold standard.
Methods: This diagnostic accuracy study was done in 2016-2017 in Two Medical and Educational Centers of Gorgan, Iran.  97 admitted patients in intensive care units, under mechanical ventilation were evaluated. The patients were recruited into the study by a convenience sampling method and evaluated for readiness to wean using two approaches (physician’s decision and using PWT). Successful weaning was considered as the ability of patient to breathe spontaneously during the first 48 hours after weaning. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR), as well as the agreement (kappa coefficient) between the two approaches, were calculated. In addition, to compare the differences between variables in two groups, chi-Square, T and man-Whitney tests were used. All analyses were performed using SPSS software ver.16, and MedCalc program ver.13. P<0.05 was considered as statistically significant.
Results: Most patients (64.9%) were men. The mean age, duration of hospital admission, and duration of mechanical ventilation of the participants were 46.49±18.15 years, 67.11±7.14 days, and 31.5±2.5 days, respectively. Weaning was successful in 87.6% of the patients. PWT had a significant agreement with the physician’s choice (kappa coefficient=0.637, P<0.001) with sensitivity, specificity, PPV, NPV, PLR, and NLR of 100%, 50%, 93.4%, 100%, 2, and 0, respectively. The cut-off level of 53 was considered as the best point to improve the diagnostic accuracy to 92.94%, 75%, 96.3%, 60%, 3.72, and 0.094, respectively.
Conclusions: Findings showed that PWT is an accurate tool for predicting the readiness of patients for weaning objectively. This tool can be used as a complementary approach by physicians and other care providers in intensive care units.

Full-Text [PDF 553 kb]   (377 Downloads) |   |   Full-Text (HTML)  (86 Views)  
Type of Study: Original Article | Subject: Nursing

1. Slutsky AS. History of mechanical ventilation. From Vesalius to ventilator-induced lung injury. Am J Respir Crit Care Med. 2015; 191(10):1106-15. [View at paplisher] [DOI] [Google Scholar]
2. Dellaca RL, Veneroni C, Farre' R. Trends in mechanical ventilation: are weventilating our patients in the best possible way? Breathe. 2017; 13(2):84-98. [View at paplisher] [DOI] [Google Scholar]
3. Klompas M, Khan Y, Kleinman K, Evans RS, Lloyd JF, Stevenson K, et al. Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation. PLoSOne. 2011; 6(3):e18062. [View at paplisher] [DOI] [Google Scholar]
4. Sellares J, Ferrer M, Cano E, Loureiro H, Valencia M, Torres A. Predictors of prolonged weaning and survival during ventilator weaning in a respiratory ICU. Intensive Care Med. 2011; 37(5):775-84. [View at paplisher] [DOI:] [Google Scholar]
5. Zein H, Baratloo A, Negida A, Safari S. Ventilator weaning and spontaneous breathing trials; an educational review. Emergency. 2016; 4(2):65-71. [View at paplisher] [DOI] [Google Scholar]
6. MacIntyre NR. Evidence-based assessments in the ventilator discontinuation process. Respir Care. 2012; 57(10):1611-8. [View at paplisher] [DOI] [Google Scholar]
7. Hsu J-C, Chen Y-F, Chung W-S, Tan T-H, Chen T, Chiang JY. Clinical verification of a clinical decision support system for ventilator weaning. Biomed Eng Online. 2013; 12:S4. [View at paplisher] [DOI] [Google Scholar]
8. Chaiwat O, Sarima N, Niyompanitpattana K, Komoltri C, Udomphorn Y, Kongsayreepong S. Protocol-directed vs. Physician-directed weaning from ventilator in intra-abdominal surgical patients. J Med Assoc Thai. 2010; 93(8):930-6. [View at paplisher] [Google Scholar]
9. Danckers M, Grosu H, Jean R, Cruz RB, Fidellaga A, Han Q, et al. Nurse-driven, protocol-directed weaning from mechanical ventilation improvesclinical outcomes and is well accepted by intensive care unit physicians. J Crit Care. 2013; 28(4):433-41. [View at paplisher] [DOI] [Google Scholar]
10. Dehghani A, Abdeyazdan G, Davaridolatabadi E. An overview of the predictor standard tools for patient weaning from mechanical ventilation. Electronic physician. 2016; 8(2):1955. [View at paplisher] [DOI] [Google Scholar]
11. Irajpour A, Khodaee M, Yazdannik A, Abbasi S. Developing a readiness assessment tool for weaning patients under mechanical ventilation. Iran J Nurs Midwifery Res. 2014; 19(3):273-8. [View at paplisher] [Google Scholar]
12. Bazrafshan F, Irajpour A, Abbasi S, Mahaki B.Validity and reliability of "Persian Weaning Tool" in mechanically ventilated patients. Adv Biomed Res. 2016; 5:157 [View at paplisher] [DOI] [Google Scholar]
13. Ebrahimabadi S, Moghadam AB, Vakili M, Modanloo M, Khoddam H. Studying the power of the integrative weaning index in predicting the success rate of the spontaneous breathing trial in patients under mechanical ventilation. Indian J Crit Care Med. 2017; 21(8):488-493. [View at paplisher] [DOI] [Google Scholar]
14. Nemer SN, Barbas CS, Caldeira JB, Cárias TC, Santos RG, Almeida LC, et al. A new integrative weaning index of discontinuation from mechanical ventilation. Critical Care. 2009; 13(5):R152. [View at paplisher] [DOI] [Google Scholar]
15. Boniatti VM, Boniatti MM, Andrade CF, Zigiotto CC, Kaminski P, Gomes SP, et al. The modified integrative weaning index as a predictor of extubation failure. Respir Care. 2014; 59(7):1042-7. [View at paplisher] [DOI] [Google Scholar]
16. Monaco F, Drummond G, Ramsay P, Servillo G, Walsh T. Do simple ventilation and gas exchange measurements predict early successful weaning from respiratory support in unselected general intensive care patients? Br J Anaesth. 2010; 105(3):326-33. [View at paplisher] [DOI] [Google Scholar]
17. Mabrouk AA, Mansour OF, El-Aziz AAA, Elhabashy MM, Alasdoudy AA. Evaluation of some predictors for successful weaning from mechanical ventilation. Egyptian Journal of Chest Diseases and Tuberculosis. 2015; 64(3):703-7. [View at paplisher] [DOI] [Google Scholar]
18. Wu YK, Kao KC, Hsu KH, Hsieh MJ, Tsai YH. Predictors of successful weaning from prolonged mechanical ventilation in Taiwan. Respir Med. 2009; 103(8):1189-95. [View at paplisher] [DOI] [Google Scholar]
19. Savi A, Teixeira C, Silva JM, Borges LG, Pereira PA, Pinto KB, et al. weaning predictors do not predict extubation failure in simple-to-wean patients. J Crit Care. 2012; 27(2):221. E1-. e8. [View at paplisher] [DOI] [Google Scholar]
20. Perren A, Previsdomini M, Llamas M, Cerutti B, Györik S, Merlani G, et al. Patients' prediction of extubation success. Intensive Care Med. 2010; 36(12):2045-52. [View at paplisher] [DOI] [Google Scholar]
21. Penuelas O, Frutos-Vivar F, Fernandez C, Anzueto A, Epstein SK, Apezteguia C, et al. Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation. Am J Respir Crit Care Med. 2011; 184(4):430-7. [View at paplisher] [DOI] [Google Scholar]
22. Blackwood B, Alderdice F, Burns KE, Cardwell CR, Lavery G, O'Halloran P. Protocolized versus non-protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients. Cochrane Database Syst Rev. 2010; (5):Cd006904. [View at paplisher] [DOI]
23. Rojek-Jarmuła A, Hombach R, Krzych ŁJ. APACHE II score cannot predict successful weaning from prolonged mechanical ventilation. Chronic respiratory disease. 2017; 14(13):270-5. [DOI] [Google Scholar]
24. West RR, Saidi M, Dawson D. Protocol-driven weaning from mechanical ventilation: a study into adherence and outcomes. Critical Care. 2009; 13(1):P24. [View at paplisher] [DOI] [Google Scholar]
25. Turan Inal M, Memiş D, Yildirim İ. Comparıson of extubatıon tımes between protocolızed versus automated weanıng systems after major surgery ın the ıntensıve care unıt. Signa vitae: journal for intesive care and emergency medicine. 2012; 7(1):23-7. [View at paplisher] [DOI] [Google Scholar]
26. Rose L,Schultz MJ, Cardwell CR, Jouvet P, McAuley DF, Blackwood B. Automated versus non-automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children: a cochrane systematic review and meta-analysis. Crit Care. 2015; 19:48. [View at paplisher] [DOI] [Google Scholar]
27. Burns KE, Lellouche F, Nisenbaum R, Lessard MR, Friedrich JO. Automated weaning and SBT systems versus non‐automated weaning strategies for weaning time in invasively ventilated critically ill adults. Cochrane Database of Systematic Reviews. 2014. [View at paplisher] [DOI] [Google Scholar]
28. Kataoka G, Murai N, Kodera K, Sasaki A, Asano R, Ikeda M, et al. Clinical experience with Smart Care after off-pump coronary artery bypass for early extubation. J Artif Organs. 2007; 10(4):218-22. [DOI] [Google Scholar]
29. Madani SJ, Saghafinia M, Nezhad HS, Ebadi A, Ghochani A, Tavasoli AF, et al. Validity of integrative weaning index of discontinuation from mechanical ventilation in Iranian ICUs. Thrita. 2013; 2:62-8. [View at paplisher] [DOI] [Google Scholar]

Add your comments about this article : Your username or Email:

Send email to the article author

© 2020 All Rights Reserved | Journal of Research Development in Nursing & Midwifery

Designed & Developed by : Yektaweb