Validation of New Integrative Weaning Index during Weaning from Mechanical Ventilation in Patients with Chronic Obstructive Pulmonary Disease: A Prospective Observational Study

Chronic Obstructive Pulmonary Disease patients are certainly the most challenging ones for weaning from mechanical ventilation. Mortality in these patients compared to others due to failure in the weaning process is more than seven times. The present study was performed on the population of ventilated chronic obstructive pulmonary disease purposes of determining cut-off points of New Integrative Weaning Index (NIWI) and conventional indexes and comparing differences between their predictive components.

The observational prospective, triple blinded study was conducted in 2012-2013 on 180 hospitalized COPD patients in critical care units of selected hospitals in Tehran in two groups including cut-off points determining group and determining different predicting weaning factors group. The process of weaning was based on the same and defined protocol. The ROC analysis was used to determine the cut-off points group and the predicting factors were used in the other group.

The highest area under the curves was devoted to Rapid Shallow Breathing Index (0.927) and NIWI (0.878). The highest sensitivity was related to NIWI with 100% and the highest specificity was related to RSBI index 90%, the positive predictive value to RSBI Index was 87.5%, the negative predictive value to NIWI with 100% and highest diagnostic accuracy related to RSBI was 98.67%. The cut-off point and the most desirable components predicting weaning were RSBI, NIWI, P0.1, and NIF indexes, respectively.

The NIWI index can be used as a complementary predictive indicator for weaning from mechanical ventilation in chronic obstructive pulmonary disease patients due to its good predictive components.