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Peripheral perfusion index as a predictor of failed weaning from mechanical ventilation

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We hypothesized that impairment of peripheral perfusion index (PPI) during spontaneous breathing trial (SBT) might be predictive of weaning failure. We included 44 consecutive, adult, patients, who were scheduled for weaning after at least 48 h of invasive mechanical ventilation in this prospective observational study. Weaning failure was defined as failed SBT or reintubation within 48 h of extubation. PPI readings were obtained before initiation of the SBT, and every 5 min till the end of the SBT. PPI ratio was calculated at every time point as: PPI value/ baseline PPI. The primary outcome was the accuracy of PPI ratio at the end of the SBT in detecting failed weaning. Forty-three patients were available for the final analysis. Eighteen patients (42%) were considered failed weaning. PPI ratio was higher in patients with successful weaning compared to patients with failed weaning during the last 15 min of the SBT. PPI ratio at the end of SBT was higher in patients with successful weaning compared to patients with failed weaning. PPI ratio at the end of SBT had good predictive ability for weaning failure {area under receiver operating characteristic curve (95% confidence interval): 0.833(0.688–0.929), cutoff value ≤ 1.41}. The change in PPI during SBT is an independent predictor for re-intubation. PPI could be a useful tool for monitoring the patient response to SBT. Patients with successful weaning showed higher augmentation of PPI during the SBT compared to re-intubated patients. Failure of augmenting the PPI by 41% at the end of SBT could predict re-intubation with negative predictive value of 95%. Clinical trial identifier: NCT03974568.

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Data availability

The data that support the findings of this study are available from Cairo university hospitals; however, they are not publicly available. Data are however available from the authors upon reasonable request after permission of Cairo university.


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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Correspondence to Ahmed Hasanin.

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The authors declare that they have no conflict of interest with this work.

Ethical approval

Our paper was approved by the Research Ethics Committee, Faculty of medicine, Cairo University (N-159-2018), on 16 March 2019.

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The study was conducted in Cairo University hospitals

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Lotfy, A., Hasanin, A., Rashad, M. et al. Peripheral perfusion index as a predictor of failed weaning from mechanical ventilation. J Clin Monit Comput (2020).

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  • Peripheral perfusion index
  • Weaning
  • Mechanical ventilation
  • Critically ill