Ventilator Weaning and Excursion Time Index: One Step Closer to the Quantum Leap?

Excerpt

We thank Drs. De Santo and Equinas for their comments. The patients selected for our observational study had diverse causes of respiratory failure with the most common ones being septic shock, pneumonia, neuromuscular depression, and cardiac arrest or failure. This allows our study findings to be potentially applicable to a broad group of critically ill patients. 7 out of 20 patients in the “failure” group following extubation were initiated on pre-emptive non-invasive ventilation as per the discretion of the treating ICU team. These patients, similar to other patients in the “failure” group, were found to have lower diaphragmatic excursion on serial ultrasonography during spontaneous breathing trials compared to that during assist control mode of ventilation. The “success” and “failure” groups were similar with regards to their co-morbidities, the severity of critical illness as determined by the APACHE IVa score, and had potentially similar factors influencing the outcome of extubation. Dissimilar extubation outcomes between “success” and “failure” groups were more likely to be a sequel of their disparate diaphragm function as measured by ultrasound [1]. …