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Neurocritical Care
Published in: Neurocritical Care 1/2008

01-08-2008 | Original Article

The Prediction of Extubation Success of Postoperative Neurosurgical Patients Using Frequency–Tidal Volume Ratios

Authors: Milena C. Vidotto, Luciana C. M. Sogame, Christiane C. Calciolari, Oliver A. Nascimento, José R. Jardim

Published in: Neurocritical Care | Issue 1/2008

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Abstract

Background

The process of discontinuing neurological patients from mechanical ventilation is still controversial. The aim of this study was to report the outcome from extubating patients undergoing elective craniotomy and correlate the result with the measured f/V t ratio.

Materials and Methods

In a cohort prospective study, all consecutive patients who required mechanical ventilation for up to 6 h after elective craniotomy were eligible for inclusion in this study. Patients passing daily screening criteria automatically received a spontaneous breathing trial (SBT). Immediately previous to the extubation, the expired minute volume (VE), breathing frequency (f), and tidal volume (V t) were measured and the breathing frequency-to-tidal volume ratio (f/V t) was calculated; consciousness level based on Glasgow Coma Scale (GCS) was evaluated at the same time. The extubation was considered a failure when patients needed reintubation within 48 h.

Results

Ninety-two patients were extubated and failure occurred in 16%. Despite 15 patients failed extubation just one of them presented the f/V t score over 105. The best cutoff value for f/V t observed was 62, but with low specificity (0.53) and negative predictive values (0.29). Area under the ROC curve for the f/V t was 0.69 ± 0.07 (P = 0.02). Patients who failed the extubation process presented higher incidence of pneumonia (80%), higher need for tracheostomy (33%) and mortality rate of 40%.

Conclusion

The f/V t ratio does not predict extubation failure in patients who have undergone elective craniotomy. Patients who fail extubation present higher incidence of pneumonia, tracheostomy and higher mortality rate.
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Metadata
Title
The Prediction of Extubation Success of Postoperative Neurosurgical Patients Using Frequency–Tidal Volume Ratios
Authors
Milena C. Vidotto
Luciana C. M. Sogame
Christiane C. Calciolari
Oliver A. Nascimento
José R. Jardim
Publication date
01-08-2008
Publisher
Humana Press Inc
Published in
Neurocritical Care / Issue 1/2008
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-008-9059-x

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