Application value of enhanced recovery management in difficult weaning

Objective To explore the feasibility and safety of enhanced recovery management in difficult weaning.

Methods A total of 40 patients with difficulty weaning in the ICU of Eastern Division of Suzhou Municipal Hospital from January 2020 to May 2021 were selected. They were divided into control group (n=20) and enhanced recovery group (n=20) according to whether accelerated rehabilitation management was implemented or not. The area and thickness of the left rectus femoris muscle were measured by ultrasound on the 1st, 3rd and 7th day of treatment. Diaphragm thickness was measured by ultrasound at 30 min after spontaneous breathing test (SBT) or when SBT failed and re-ventilated. Rapid shallow breathing index (RSBI) was measured by ventilator. Patients who met the clinical weaning criteria were weaned, and the duration of mechanical ventilation, length of ICU stay, and ICU cost were recorded. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of RSBI and diaphragmatic thickening fraction (DTF) on weaning outcomes in patients with difficult weaning.

Results The mechanical ventilation time and ICU stay time in the enhanced recovery group were significantly shorter than those in the control group (P < 0.05). The differences of left rectus femoris muscle area and left rectus femoris muscle thickness between 1 d and 3 d of treatment, between 1 d and 7 d of treatment in the enhanced recovery group were significantly lower than those in the control group (P < 0.01). The DTF of the control group was significantly lower than that of the enhanced recovery group, and RSBI was significantly higher than that of the enhanced recovery group (P < 0.05). The area under the curve (AUC) of RSBI and DTF were 0.714 and 0.687, respectively. When the optimal cut-off value of RSBI was 105 breaths/(min·L), the sensitivity and specificity of predicting weaning failure were 88.3% and 54.6%, respectively. When the cut-off value of DTF was 30.0%, the sensitivity and specificity were 71.2% and 84.7%, respectively.

Conclusion Enhanced recovery management can effectively shorten the duration of mechanical ventilation and hospital stay in ICU patients with difficulty weaning, and can effectively prevent ICU acquired weakness and diaphragmatic dysfunction. Ultrasonic monitoring DTF has certain guiding value for predicting difficult weaning.