Successful weaning of adult patients with respiratory failure from mechanical ventilators using an L-piece

Ukris Utensute

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Successful weaning of adult patients with respiratory failure from mechanical ventilators using an L-piece

Ukris Utensute

| 31 mars 2017

Asian Biomedicine

Édition 10 (2016): Edition 5 (October 2016)

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Article Category: Brief communication (Original)

Publié en ligne: 31 mars 2017

Pages: 469 - 476

DOI: https://doi.org/10.5372/1905-7415.1005.510

Mots clés
Extubation, failed weaning, L-piece, respiratory failure, successful weaning, ventilator

© 2016 Ukris Utensute

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

A comparison of the T-piece and an L-piece

Number of adult patients with respiratory failure successful weaned using an L-piece in each year

Year	Ventilator cases	L-piece (n)	Percent using L-piece	Sex		Success	Failure	Success rate

				Male	Female
2012	152	34	22.4%	16	18	32	2	94.1%
2013	155	43	27.7%	23	20	41	2	95.4%
2014	173	39	22.5%	30	9	38	1	97.4%
2015	101	27	26.7%	19	8	25	2	92.6%
Total	581	143	24.9%	88	55	136	7	95.1%

Relation of factors between success and failure group

Factors (n =143)	Success group (n = 136)		Failure group (n = 7)		Odds ratio	95% CI	P

	Cases	Percentage	Cases	Percentage
A. Age group (years old)
18–40	9^{b = No significant difference between ages 18–40 and 41–60 years, or between ages 18–40 and 61–80 years}	100.0	0	0.0	–	–	1.0000^ns
41–60	50^{a = Fisher’s exact test, ns = not significant.}	96.2	2	3.8	1
61-80	77^{a = Fisher’s exact test, ns = not significant.}	93.9	5	6.1	0.6	0.1–4.0	0.5682^ns
B. Cigarettes
Active smoker	29^{a = Fisher’s exact test, ns = not significant.}	96.7	1	3.3	1
Nonsmoker	71^{a = Fisher’s exact test, ns = not significant.}	94.7	4	5.3	0.6	0.01–6.6	1.0000^ns
Quit	36^{a = Fisher’s exact test, ns = not significant.}	94.7	2	5.3	0.6	0.01–12.0	1.0000^ns
C. Sex
Male	86^{a = Fisher’s exact test, ns = not significant.}	97.7	2	2.3	1
Female	50^{a = Fisher’s exact test, ns = not significant.}	90.9	5	9.1	0.2	0.02–1.5	0.1070^ns
D. Duration ofintubation
2–4 days	69^{a = Fisher’s exact test, ns = not significant.}	95.8	3	4.2	1
5–7 days	38^{a = Fisher’s exact test, ns = not significant.}	95.0	2	5	0.8	0.1–10.3	1.0000^ns
8–10 days	16^{c = No significant difference between duration of intubation in 2–4 and 8–10 days, or 2–4 and >14 days.}	100.0	0	0.0	–	–	1.0000™
11–14 days	5^{a = Fisher’s exact test, ns = not significant.}	71.4	2	28.6	0.1	0.01-1.7	0.06^ns
>14 days	8^{c = No significant difference between duration of intubation in 2–4 and 8–10 days, or 2–4 and >14 days.}	100.0	0	0.0	–	–	1.0000^ns
E. Reason for ventilator support
Acute on top of chronic	27^{e = No significant difference between acute on top chronic respiratory disease group and other groups.}	100.0	0	0.0	–	–	1.000^ns
respiratory disease
New respiratory disease	25^{a = Fisher’s exact test, ns = not significant.}	92.6	2	7.4	1
Congestive heart failure	41^{a = Fisher’s exact test, ns = not significant.}	97.6	1	2.4	3.3	0.2–198	0.556^ns
Neuromuscular disease	0	0.0	0	0.0	–	–	–
Cardiopulmonary arrest	13^{f = No significant difference between cardiopulmonary arrest group and other groups.}	100.0	0	0.0	–	<	>0.99^ns
Other	30^{a = Fisher’s exact test, ns = not significant.}	88.2	4	11.8	0.6	0.1–4.6	0.685^ns
F. Oxygen flow during weaning
1–3 L/min	47^{a = Fisher’s exact test, ns = not significant.}	92.2	4	7.8	1
4–6 L/min	89^{a = Fisher’s exact test, ns = not significant.}	96.7	3	3.3	2.5	0.4-17.8	0.248™
G Rapid shallow breathing index during ventilator support
<40 years old	64^{a = Fisher’s exact test, ns = not significant.}	92.8	5	7.2	1
41–60 years old	60^{a = Fisher’s exact test, ns = not significant.}	98.4	1	1.6	4.7	0.5, 225.3	0.213^ns
61–80 years old	11^{g = No significant difference between rapid shallow breathing index during ventilator support between the 61–80-year-old age group and other age groups.}	100.0	0	0.0	–	–	1.000^ns
>80 years old	1^{a = Fisher’s exact test, ns = not significant.}	50.0	1	50.0	0.1	0.001, 7.4	0.163^ns
H. MV during ventilator support
4.0–6.0 L/min	12	100.0	0	0.0	–	–	1.000^ns
6.1–8.0 L/min	43^{a = Fisher’s exact test, ns = not significant.}	91.5	4	8.5	1
8.1–10.0 L/min	54^{a = Fisher’s exact test, ns = not significant.}	96.4	2	3.6	2.5	0.3, 28.7	0.408^ns
>10 L/min	27^{a = Fisher’s exact test, ns = not significant.}	96.4	1	3.6	2.5	0.2, 128.2	0.645^ns
I. Oxygen Saturation during weaning
90–92%	7	100.0	0	0.0	–	–	1.000^ns
93–95%	12^{a = Fisher’s exact test, ns = not significant.}	92.3	1	7.7	1
96–98%	27^{a = Fisher’s exact test, ns = not significant.}	96.4	1	3.6	2.3	0.03, 183.0	0.539^ns
99–100%	90^{a = Fisher’s exact test, ns = not significant.}	94.7	5	5.3	1.5	0.03, 15.1	0.546^ns

Comparison of vital signs of the patients during ventilator support and during weaning by using a L-piece

Vital signs	Success group (n = 136)			Failure group (n = 7)			Total (n = 143)

	Mean	SD	P	Mean	SD	P	Mean	SD	P
Respiratory rate
On ventilator support	18.2	3.8		19.4	6.0		18.3	3.8
On L-piece	19.6	3.8	<0.001^*	23.7	2.9	0.107^ns	19.8	3.9	<0.001^*
Mean blood pressure (mmHg)
On ventilator support	94.0	12.8		93.7	10.8		94.0	12.6
On L-piece	95.8	12.0	0.044^*	88.0	15.6	0.091^ns	95.4	12.3	0.099^ns
Heart rate (bpm)
On ventilator support	86.3	15.0		86.7	9.8		86.4	14.8
On L-piece	87.1	14.8	0.452^ns	97.6	23.6	0.173^ns	87.6	15.3	0.22^ns
Temperature (°C)
On ventilator support	37.0	0.7		37.1	0.7		37.1	0.7
On L-piece	36.9	0.5	0.035^*	37.2	0.9	0.553^ns	37.0	0.5	0.056^ns
Oxygen saturation
On ventilator support	98.5	2.2		99.9	0.4		98.5	2.2
On L-piece	98.5	2.6	0.93^ns	98.7	2.0	0.11^ns	98.5	2.5	0.81^ns

Data of all failure cases

Case	Sex	Age (y)	Duration of intubation (days)	Reason for intubation	Reintubation time	Reason for reintubation	Final result
1	F	79	2	Others	<24 h	Vocal cord edema	Weaning L-piece; success, discharged
2	M	68	6	Congestive heart failure	<24 h	Pulmonary edema	Weaning L-piece; success, discharged
3	F	45	14	Others	36 h	Secretion obstruction	Weaning L-piece; success, discharged
4	F	74	11	New respiratory disease	<24 h	Secretion obstruction	Tracheostomy, discharged
5	F	55	3	Others	<24 h	Alteration of consciousness	Self extubation, discharged
6	F	62	5	Others	<24 h	Vocal cord edema	Weaning L-piece; success, discharged
7	M	78	2	New respiratory disease	<24 h	Secretion obstruction	Tracheostomy, discharged

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Successful weaning of adult patients with respiratory failure from mechanical ventilators using an L-piece

Article Category: Brief communication (Original)

Publié en ligne: 31 mars 2017

Pages: 469 - 476

DOI: https://doi.org/10.5372/1905-7415.1005.510

Mots clésExtubation, failed weaning, L-piece, respiratory failure, successful weaning, ventilator

© 2016 Ukris Utensute

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Number of adult patients with respiratory failure successful weaned using an L-piece in each year

Relation of factors between success and failure group

Comparison of vital signs of the patients during ventilator support and during weaning by using a L-piece

Data of all failure cases

Mots clés
Extubation, failed weaning, L-piece, respiratory failure, successful weaning, ventilator