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Background: To develop ten new integrated weaning indices that can predict the weaning outcome better than the traditional indices. Methods: This retrospective-prospective derivation-validation observational multicenter clinical trial (Clinical Trial.Gov, NCT01779297), was conducted on 1,175 adult patients admitted at 9 academic affiliated intensive care units (ICUs; 4 surgical and 5 medical), from Jan 2013 to Dec 2018. All patients, intubated and mechanically ventilated for at least 24 h and ready for weaning were enrolled. The study had two phases: at first, the threshold values of each index that best discriminate between a successful and an unsuccessful weaning outcome was determined among 208 patients in the derivation group. In the second phase, the predictive performance of these values was prospectively tested in 967 patients in the validation group. In the prospective-validation set we used Bayes' theorem to assess the probability of each test in predicting weaning. Results: In the prospective validation group, sensitivity, specificity, diagnostic accuracy, positive and negative predictive values, and finally area under the receiver operator characteristic curves and standard errors for each index (ten formulae) were calculated. Statistical values of ten formulae for aforesaid variables were higher than 87% (0.87-0.99). Conclusion: The new indices can be used for hospitalized patients in intensive care settings for accurate prediction of the weaning outcome.

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BACKGROUND: Patients undergoing mechanical ventilation in the ICU often receive supplemental oxygen. If not closely monitored, this may lead to hyperoxia. The use of an oxygen-weaning protocol may reduce this risk by pacing the titration of oxygen therapy to patient needs. ICU protocols are correlated with decreased mortality and length of stay and have great potential for cost savings. The goals of this study were to determine whether the oxygen-weaning protocol at a university-affiliated hospital was followed and to measure the length of time respiratory therapists took to wean patients once the oxygen-weaning parameters were met. METHODS: This was a retrospective chart review of subjects > 18 y of age admitted to the medical ICU who underwent intubation and mechanical ventilation and were placed on an oxygen therapy protocol. The following data were collected: demographics, arterial blood gases, the length of time to change [Formula: see text] after meeting weaning parameters, and the percent change in [Formula: see text]. RESULTS: Data were collected from 30 subjects. The most common oxygen saturation parameter measured via pulse oximetry ([Formula: see text]) used to initiate weaning oxygen was 92%. The mean ± SD [Formula: see text] administered to subjects was 39.6 ± 15.3% prior to extubation. The majority of subjects exhibited adequate oxygenation prior to extubation (mean ± SD): [Formula: see text] 99.3 ± 6.7 mm Hg, [Formula: see text] 95.1 ± 26.9%. The mean ± SD length of time to the first change in [Formula: see text] from the time a subject met the weaning criteria was 9.1 ± 10.6 h (range 1-39 h; interquartile range 2-13 h). CONCLUSIONS: Subjects admitted to the medical ICU who were intubated, mechanically ventilated, and placed on the oxygen therapy protocol experienced a significant delay in oxygen weaning. Closer monitoring and adherence to the oxygen-weaning protocol should be considered to reduce the potential risk for hyperoxia.

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BACKGROUND: A number of indices have been proposed as accurate predictors of weaning, but several studies have questioned the accuracy of these weaning indices in predicting the capability of independent breathing. The purpose of the study was to assess six standard bedside weaning indices and respiratory rate and tidal volume ratio (RRVT) of mechanically ventilated patients in the surgical intensive care unit (SICU). METHODS: The study was performed on 90 SICU patients who were mechanically ventilated. According to the outcome of weaning, they were divided into two groups, weaning success (n = 83) and weaning failure (n = 7). All subjects should have a PaO2 above 60 mmHg at an FiO2 of 0.4 and PEEP of 3 5 cmH2O and no PEEP in the extubated patients at the time of the weaning. Bedside weaning indices were respiratory rate (RR), tidal volume (VT), minute volume (VE), maximum inspiratory pressure (Pimax), vital capacity (VC), PaO2/FiO2 and RRVT. The predictive variables - sensitivity, specificity - of indices were calculated, and the data was also analysed with receiver-operating-characteristic (ROC) curves. RESULTS: Sensitivity was highest for VT (0.95), followed closely by the PaO2/FiO2 (0.94). Specificity was highest for Pimax (0.28). The VT was the best predictor of successful weaning, and Pimax was the best predictor of failure. The order of the area under the ROC curves was VC (0.761) followed by VE (0.636), VT (0.631), Pimax (0.546), PaO2/FiO2 (0.474), RR (0.457), and RRVT (0.339). CONCLUSIONS: Those weaning indices are good predictors of weaning success, but poor predictors of weaning failure. RRVT does not predict the weaning outcome.

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