Respiratory Failure & Mechanical Ventilation

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85 years old male who was admitted with acute respiratory failure and ARDS secondary aspiration pneumonia. Patient was treated with ceftriaxone, bronchoscopy with clearance of sectretions, and protective lung strategy. His condition improved but required to be tracheotomized due to his inability to protect the airway. He was placed on adaptive mode of ventilation (ASV) at minute ventilation of 80%. His ideal body weight is 65 kg. A screenshot of his ventilator is shown below:

The patient is minimally responsive by opening eyes and he does not seem to be in any respiratory distress. Please observe the above screenshot and provide your feedback.

A study published in critical care journal investigated the predictive ability of various tests for successful weaning from mechanical ventilation and extubation in a prospective, multicenter observational study involving 367 adult patients across four intensive care units. Researchers focused on the cuff leak test, rate of rapid and shallow breathing, cough intensity (0 to 3), and diaphragmatic contraction velocity (DCV) to determine their utility in forecasting the outcome of spontaneous breathing trials (SBT) and extubation.

Key findings include:

• Out of 456 SBTs performed, the success rate was 76.5%.

• An equation for predicting SBT success was developed, combining cough intensity and DCV. With a cutoff point of ≥0.83, the prediction had a high sensitivity of 91.5% but a low specificity of 22.1%, with an overall accuracy of 76.2%. The area under the receiver operating characteristic (ROC) curve was modest at 0.63.

(0.56 × Cough) − (0.13 × DCV) + 0.25

• Another equation to predict extubation success was also created,…