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Weaning Prediction

Esophageal Pressure Monitoring Complements Readiness Testing

Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, Illinois; and State University of New York at Buffalo, and Veterans Affairs Health Care System of Western New York, Buffalo, New York

Correspondence and requests for reprints should be addressed to Amal Jubran, M.D., Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. VA Hospital, 111N 5th Avenue and Roosevelt Road, Hines, IL 60141. E-mail: ajubran{at}lumc.edu

Several variables are recommended for identifying if a patient is ready for a trial of weaning from mechanical ventilation, but there is no agreement as to whether monitoring any variable during the trial enhances patient management. To determine whether repeated measurements of esophageal pressure throughout a trial are more reliable than measurements of esophageal pressure or frequency-to-VT ratio during the first minute of the trial, we studied 60 patients. A trend index that quantified esophageal pressure swings over time was more reliable than the first-minute measurements: sensitivity, 0.91, and specificity, 0.89. Area under receiver operating characteristic curve for trend index (0.94) was greater than for first-minute measurement of esophageal pressure (0.44, p < 0.05) and tended to be greater than that for frequency-to-VT ratio (0.78, p = 0.13). The likelihood ratio was highest for the trend index (8.2, p < 0.05). The advantage of the trend index may be related to the progressive increase in esophageal pressure throughout a failed weaning trial, whereas breathing pattern changed little after 2 minutes of spontaneous breathing. In conclusion, continuous monitoring of esophageal pressure swings during a spontaneous breathing trial provides additional guidance in patient management over tests used for deciding when to initiate weaning.

Key Words: esophageal pressure • monitoring • weaning

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