The predictive value of Montreal Cognitive Assessment score for weaning outcomes in patients with me-chanical ventilation in intensive care unit
10.3969/j.issn.1001-1242.2024.06.007
- VernacularTitle:蒙特利尔认知量表评分在ICU机械通气患者脱机中的预测价值
- Author:
Jinze TAN
1
,
2
;
Lei ZHANG
;
Wenjun PANG
Author Information
1. 南方医科大学第二临床医学院,广州市,510080
2. 南方医科大学附属广东省人民医院(广东省医学科学院)康复医学科
- Keywords:
ICU rehabilitation;
weaning;
mechanical ventilation;
MoCA score;
predictive value
- From:
Chinese Journal of Rehabilitation Medicine
2024;39(6):804-812,827
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the predictive value of Montreal Cognitive Assessment(MoCA)score for weaning out-comes in patients with mechanically ventilation in ICU. Method:The study enrolled 127 mechanically ventilated patients admitted to the intensive care unit of Guang-dong provincial people's hospital from October 2022 to August 2023,including 85 males and 42 females.All patients were evaluated within 24 hours of ICU admission for general information and clinical data such as MoCA score,ventilation volume(MV),Apache Ⅱ score,tidal volume(VT),shallow rapid breathing index(RSBI),oxygenation index(OI),blood gas analysis,and the duration of mechanical ventilation before a spon-taneous breathing trial.Outcomes of weaning were then evaluated,dividing patients into a successful weaning group(92 patients)and a weaning failure group(35 patients).Univariate analysis identified factors related to weaning failure;multivariable binary logistic regression determined risk and protective factors affecting the weaning outcome,calculating odds ratio(OR),95％confidence interval(95％CI)and accuracy(Acc).The receiver operating characteristic(ROC)curve of MoCA score was drawn to calculate the area under the curve(AUC),Yolden index(YI),cutoff value(Cut off),sensitivity(Se),specificity(Sp)to analyze the predic-tive value of the MoCA score in weaning mechanically ventilated patients. Result:There were no significant differences between the two groups in general data except for BMI index(P＞0.05).Significant differences were observed in Apache-Ⅱ scores,MoCA scores,PaO2,VT,MV,and the dura-tion of mechanical ventilation(P＜0.05).Binary logistic multivariate regression analysis showed that a higher Mo-CA score(OR=0.824,95％CI:0.720-0.944,P=0.005)was an independent protective factor for weaning out-comes.Higher minute ventilation(OR=0.600,95％CI:0.416-0.865,P=0.006)was also an independent protec-tive factor for weaning outcomes.AUC for MoCA score was 0.746(95％CI:0.661-0.819,P=0.001)with an optimal cutoff value of 20 points,corresponding sensitivity(Se)of 77.14％,specificity(Sp)of 68.48％and pre-diction accuracy(Acc)of 74.02％. Conclusion:A higher MoCA score is an independent protective factor influencing weaning outcomes.A MoCA score ≤ 20 increases the risk of weaning failure.Higher MoCA scores correlate with higher success rate of weaning;each one-point increase in MoCA score increases the success rate of 17.6％.
