espiratory Muscle Assessment in Predicting Extubation Outcome in Patients ith Stroke

Background: Patients with cerebral infarction often present impaired consciousness and unsatisfactory extubation. We aimed to assess the respiratory mechanics components that might be associated with the success of extubation in stroke patients. Methods: Twenty consecutive patients with stroke who needed mechanical ventilation support were enrolled. The maximal inspiratory pressure, gastric and the esophageal pressure (Pdi/Pdimax), minute volume, respiratory rate, static compliance, airway resistance, rapid shallow breathing index (RSBI), inspiratory time/total respiratory cycle (Ti/Ttot), and PaO2/FiO2 were measured. Results: The group who presented success to the extubation process presented 12.5±2.2=days in mechanical ventilation and the group who failed presented 13.1±2=days. The mean Ti/Ttot and Pdi/Pdimax for the failure group were 0.4±0.08 (0.36–0.44) and 0.5±0.7 (0.43–0.56), respectively. The Ti/Ttot ratio was 0.37±0.05 (0.34–0.41; P=.0008) and the Pdi/Pdimax was 0.25±0.05 for the success group (0.21–0.28; P<.0001). A correlation was found between Pdi/Pdimax ratio and the RSBI (r=0.55; P=.009) and PaO2/FiO2 (r=−0.59; P=.005). Patients who presented a high RSBI (OR, 3.66; P=.004) and Pdi (OR, 7.3; P=.002), and low PaO2/FIO2 (OR, 4.09; P=.007), Pdi/Pdimax (OR, 4.12; P=.002) and Raw (OR, 3.0; P=.02) developed mechanical ventilation extubation failure. Conclusion: Muscular fatigue index is an important predicting variable to the extubation process in prolonged mechanical ventilation of stroke patients. © 2012 SEPAR. Published by Elsevier España, S.L. All rights reserved. Evaluación de la musculatura respiratoria en la predicción del resultado de la extubación de pacientes con ictus