Weaning Outcome is Associated with ELWI and Impaired Diastolic Function

Bagka, Dimitra; Zakynthynos, George; Tsolaki, Vasiliki; Papanikolaou, Jonh; Vazgiourakis, Vasilis; Baka, Maria; Pratsas, Konstantinos; Makris, Demosthenes

doi:10.2478/jccm-2024-0008

Abstract

Objectives

To evaluate hemodynamic profiles of critical care patients undergoing spontaneous t-piece trial (SBT) and present weaning failure.

Methods

Prospective observational study conducted in ready-to-wean non-cardiac ICU patients. Clinical, echocardiographic and thermodilution-derived variables were recorded before and after a 2-hour SBT. Weaning from mechanical ventilation was defined as preservation of spontaneous breathing for 48 hours following successful SBT.

Results

Fourteen patients succeeded weaning, five manifested T-trial-failure and six late-failure. Weaning outcome was significantly associated with ELWI(Extravascular lung-water index), global-end-diastolic index and impaired diastolic function, as indicated by pre-T Doppler early wave velocities (E/Em); Fifty-six percent of participants presented ELWI≥7mL/kg when fulfilling predetermined criteria for weaning. ELWI, impaired pulmonary permeability and left ventricular diastolic dysfunction were independent determinants of ELWI.

Conclusions

ELWI before SBT and impaired diastolic function (as indicated by pre-T E/Em) might be weaning outcome determinants and their assessment may allow better risk stratification in weaning decision making.

References

Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29: 1033–1056.
Search in Google Scholar Back to article
Teboul JL, Monnet X, Richard C. Weaning failure of cardiac origin: recent advances. Crit Care. 2010;14: 211.
Search in Google Scholar Back to article
Lamia B, Monnet X, Teboul JL. Weaning-induced cardiac dysfunction. In Yearbook of Intensive Care and Emergency Medicine. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine 2005. Yearbook of Intensive Care and Emergency Medicine, vol 2005. Springer, New York, NY. pp: 239–245.
Search in Google Scholar Back to article
Dres M, Teboul JL, Anguel N, et al. Extravascular lung water, B-type natriuretic peptide, and blood volume contraction enable diagnosis of weaning-induced pulmonary edema. Crit Care Med 2014; 42:1882–1889.
Search in Google Scholar Back to article
Papanikolaou J, Makris D, Saranteas T, et al. New insights into weaning from mechanical ventilation left ventricular diastolic dysfunction is a key player. Intensive Care Med. 2011; 37:1976–1985.
Search in Google Scholar Back to article
Sakka SG, Ruhl CC, Pfeiffer UJ, et al. Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med. 2000;26:180–187.
Search in Google Scholar Back to article
Kuzkov VV, Kirov MY, Sovershaev MA, et al. Extravascular lung water determined with single transpulmonary thermodilution correlates with the severity of sepsis-induced acute lung injury. Crit Care Med. 2006; 34:1647–1653.
Search in Google Scholar Back to article
Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med. 1991; 324 (21): 1445–1450.
Search in Google Scholar Back to article
Gobel FL, Norstrom LA, Nelson RR, et al. The rate-pressure product as an index of myocardial oxygen consumption during exercise in patients with angina pectoris. Circulation. 1978; 57 (3): 549–556.
Search in Google Scholar Back to article
Mekontso-Dessap A, de Prost N, Girou E, et al. B-type natriuretic peptide and weaning from mechanical ventilation. Intensive Care Med. 2006; 32 (10):1529–1536.
Search in Google Scholar Back to article
Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogrs. 1989; 2(5):358–367.
Search in Google Scholar Back to article
Isakow W, Schuster DP. Extravascular lung water measurements and hemodynamic monitoring in the critically ill: bedside alternatives to the pulmonary artery catheter. Am J Physiol Lung Cell Mol Physiol. 2006;291:L1118–1131.
Search in Google Scholar Back to article
Anguel N, Monnet X, Osman D, et al. Increase in plasma protein concentration for diagnosing weaning-induced pulmonary oedema. Intensive Care Med. 2008; 34(7): 1231–1238.
Search in Google Scholar Back to article
Pare PD, Warriner B, Baile EM, et al. Redistribution of pulmonary extravascular water with positive end-expiratory pressure in canine pulmonary edema. Am Rev Respir Dis. 1983;127(5): 590–593.
Search in Google Scholar Back to article
Agarwal R, Aggarwal AN, Gupta D, et al. Non-invasive ventilation in acute cardiogenic pulmonary oedema. Postgrad Med J. 2005; 81(960): 637–643.
Search in Google Scholar Back to article
Gray A, Goodacre S, Newby DE, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med. 2008; 359(2): 142–151.
Search in Google Scholar Back to article
Lamia B, Maizel J, Ochagavia A, et al. Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation. Crit Care Med. 2009; 37(5):1696–1701.
Search in Google Scholar Back to article
García-Delgado M, Colmenero-Ruiz M, Fernández-Sacristán MA, Rus-Mansilla C, Fernández-Mondéjar E. Effect of a catecholamine-induced increase in cardiac output on extravascular lung water. Crit Care Med. 2001; 29 (5): 931–935.
Search in Google Scholar Back to article
Berthiaume Y, Matthay MA. Alveolar edema fluid clearance and acute lung injury. Respir Physiol Neurobiol. 2007;159 (3):350–359.
Search in Google Scholar Back to article
Lemaire F, Teboul JL, Cinotti L, et al. Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology. 1988; 69 (2):171–179.
Search in Google Scholar Back to article
Bindels AJ, van der Hoeven JG, Meinders AE. Pulmonary artery wedge pressure and extravascular lung water in patients with acute cardiogenic pulmonary edema requiring mechanical ventilation. Am J Cardiol. 1999; 84 (10):1158–1163.
Search in Google Scholar Back to article
Wu CK, Lee JK, Chiang FT, et al. Plasma levels of tumor necrosis factor-alpha and interleukin-6 are associated with diastolic heart failure through downregulation of sarcoplasmic reticulum Ca2+ ATPase. Crit Care Med. 2011; 39 (5): 984–992.
Search in Google Scholar Back to article
Rudiger A, Singer M. Mechanisms of sepsis-induced cardiac dysfunction. Crit Care Med. 2007;35(6): 1599–1608.
Search in Google Scholar Back to article
Monnet X, Anguel N, Osman D, Hazmaoui O, Richard C, Teboul JL. Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDS. Intensive Care Med. 2007;33: 448–453.
Search in Google Scholar Back to article
Jozwiak M, Teboul JL, Monnet X. Extravascular lung water in critical care: recent advances and clinical applications. Ann Intensive Care. 2015; 5:38.
Search in Google Scholar Back to article
Martin GS, Eaton S, Mealer M, Moss M. Extravascular lung water in patients with severe sepsis: a prospective cohort study. Crit Care. 2005;9:R74–82.
Search in Google Scholar Back to article
Sakka SG, Klein M, Reinhart K, Mejer-Hellmann A. Prognostic value of extravascular lung water in critically ill patients. Chest. 2002; 122: 2080–2086.
Search in Google Scholar Back to article
Bock J, Lewis F. Clinical relevance of lung water measurement. In Practical applications of fiberoptics in critical care monitoring, U, L.F.a.P., Ed.; Springer-Verlag: Berlin. 1990; pp: 164–180.
Search in Google Scholar Back to article
Gray BA, Beckett RC, Allison RC, et al. Effect of edema and hemodynamic changes on extravascular thermal volume of the lung. J Appl Physiol Respir Environ Exerc Physiol. 1984; 56: 878–890.
Search in Google Scholar Back to article
Newman EV, Merrell M, Genecin A, Monge C, Milnor WR, Mc Keever WP. The dye dilution method for describing the central circulation. An analysis of factors shaping the time-concentration curves. Circulation. 1951; 4: 735–746.
Search in Google Scholar Back to article