The following is a summary of “Ventilation distribution during spontaneous breathing trials predicts liberation from mechanical ventilation: the VISION study,” published in the January 2025 issue of Critical Care by Phoophiboon et al.
Predicting successful liberation from mechanical ventilation (MV) remains challenging, with electrical impedance tomography (EIT) offering non-invasive insights into regional ventilation.
Researchers conducted a retrospective study to evaluate whether displaying regional ventilation distribution during a Spontaneous Breathing Trial (SBT) could predict early and successful liberation from MV.
They monitored patients using EIT during the SBT, dividing the tidal image into ventral and dorsal regions for simultaneous display. The ventral-to-dorsal ventilation difference was calculated as a percentage, and its association with clinical outcomes was explored. Successful liberation was defined as passing the SBT, followed by extubation within 24 hours without reintubation for 7 days. Failure was defined by rescue therapy, reintubation within 7 days, tracheostomy, or not being extubated within 24 hours after a successful SBT. A training cohort was used for discovery, followed by a validation cohort.
The results showed that, among 98 patients analyzed, 85 (87%) passed the SBT, but rapid liberation success occurred in only 40. Reintubation was required in 13.5% of patients with extubation. The absolute ventral-to-dorsal difference was significantly smaller in successful liberations than in all failure subgroups (P < 0.0001). An absolute difference of >20% at 5 minutes of SBT was linked to liberation failure, with a sensitivity of 71%, specificity of 78%, and a positive predictive value of 81% in the validation cohort.
Investigators concluded a significant ventral-to-dorsal difference in ventilation, as indicated by EIT during SBT, might be a valuable predictor of liberation failure in patients on MV.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05243-0