Keywords
Weaning predictors
Tobin Index
P0.1/MIP ratio
Systematic review
How to Cite
Copyright © | All rights reserved.
The journal holds the exclusive copyright for the publication of this article under the terms of Brazilian law 9610/98.
Partial reproduction
The use of parts of the texts, figures and questionnaire of the article is free, being mandatory the citation of the authors and journal.
Total reproduction
It is expressly prohibited and must be authorized by the journal.
Abstract
Objective: To compare the Tobin index and the P0.1/MIP ratio as predictive factors for weaning from mechanical ventilation, in adult patients. Methods: This systematic review followed Cochrane, PRISMA, and AMSTAR 2 guidelines. It included randomized clinical trials (RCTs) that used the Tobin Index and P0.1/MIP ratio as weaning predictors. Two independent reviewers conducted article selection, risk of bias analysis (using RoB 2), and evaluated evidence quality (via GRADEpro GDT). Results: Only two studies, totaling 217 patients, met the inclusion criteria. While the Tobin Index is more frequently referenced in the literature, no significant difference in predictive accuracy as found between the two indices. However, both studies presented high risk of bias and low-quality evidence limiting the strength of the conclusions. Final considerations: Ultimately, both the Tobin Index and P0.1/MIP were considered reliable tools for predicting successful weaning from IMV, but neither showed clear superiority. Notably, ventilation time and mortality outcomes ventilation time and mortality outcomes were not adequately explored compared in the included studies.
References
BARTAL A, et al. Predictors of weaning success from prolonged mechanical ventilation: A protocol study [Internet]. In Review; 2024.
BHAGAT K. Risk Factors and Predictors of Prolonged Mechanical Ventilation Following Cardiac Surgery: A Narrative Review. Cureus, 2024.
CAPDEVÏLA XJ, et al. Occlusion Pressure and Its Ratio to Maximum Inspiratory Pressure Are Useful Predictors for Successful Extubation Following T-Piece Weaning Trial. Chest., 1995; 108(2): 482–9.
CHANG CH, et al. Higher protein intake may benefit in patients with prolonged mechanical ventilation. Front Nutr., 2024; 11: 1449240.
DOLINAY T, et al. Ventilator Weaning in Prolonged Mechanical Ventilation—A Narrative Review. J Clin Med., 2024; 13(7): 1909.
HA TS, et al. Liberation from Mechanical Ventilation in Critically Ill Patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines. Tuberc Respir Dis., 2024; 87(4): 415–39.
HUO Y, et al. Predictive efficacy of weaning index on mechanical ventilation evacuation. Ann Palliat Med., 2021; 10(1): 646–56.
KARTHIKA M, et al. Rate of Change of Rapid Shallow Breathing Index and Extubation Outcome in Mechanically Ventilated Patients. Crit Care Res Pract., 2023; 1: 9141441.
LOMBARDI FS, et al. Prediction of extubation failure in Intensive Care Unit: systematic review of parameters investigated. Minerva Anestesiol., 2019; 85(3).
MARSHALL G, et al. Association between ventilator-associated events and implementation of acute respiratory distress syndrome (ARDS) ventilator weaning protocol. Am J Infect Control., 2023; 51(12): 1321–3.
MUZETTE FM, et al. Accuracy and Sensitivity of Clinical Parameters in Predicting Successful Extubation in Patients with Acute Brain Injury. Neurol Int., 2022; 14(3): 619–27.
NEMER SN, BARBAS CSV. Predictive parameters for weaning from mechanical ventilation. J Bras Pneumol., 2011; 37(5): 669–79.
PARADA-GEREDA HM, et al. Effectiveness of diaphragmatic ultrasound as a predictor of successful weaning from mechanical ventilation: a systematic review and meta-analysis. Crit Care, 2023; 27(1): 174.
PAUDEL R, et al. Mechanical Power: A New Concept in Mechanical Ventilation. Am J Med Sci., 2021; 362(6): 537–45.
SAYED SS, et al. Predictors of spontaneous breathing outcome in mechanically ventilated chronic obstructive pulmonary disease patients. Egypt J Bronchol., 2019; 13(3): 335–42.
SILVA PL, et al. Physiological and Pathophysiological Consequences of Mechanical Ventilation. Semin Respir Crit Care Med., 2022; 43(03): 321–34.
TRIVEDI V, et al. The Usefulness of the Rapid Shallow Breathing Index in Predicting Successful Extubation. Chest, 2022; 161(1): 97–111.
TRUDZINSKI FC, et al. Risk Factors for Prolonged Mechanical Ventilation and Weaning Failure: A Systematic Review. Respiration, 2022; 101(10): 959–69.
VAHEDIAN-AZIMI A, et al. Protocolized ventilator weaning verses usual care: A randomized controlled trial. Int J Crit Illn Inj Sci., 2020; 10(4): 206.
VARGAS F, et al. Respiratory failure in chronic obstructive pulmonary disease after extubation: value of expiratory flow limitation and airway occlusion pressure after 0.1 second (P0.1). J Crit Care, 2008; 23(4): 577–84.
WANG Y, et al. Weaning critically ill patients from mechanical ventilation: a protocol from a multicenter retrospective cohort study. J Thorac Dis., 2022; 14(1): 199–206.