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

Figures & Tables

Extravascular lung water index (EVLWI) and E/Tissue Doppler Imaging early diastolic velocity (E/Em) in patients undergoing a spontaneous breathing trial before (Pre SBT) and following (End SBT) the trial, according to trial outcome (Median values, inter-quartile range and 10–90th percentiles are presented).

Stroke Volume Index (SVI) against central venous pressure (CVP) plot and Frank Starling curve representations in participants during spontaneous breathing and mechanical ventilation. Open circles represent successful weaning, closed circles represent weaning failure; SB-FSc=Frank-Starling’s curve at spontaneous breathing; MV-FSc= Frank-Starling’s curve during mechanical ventilation.

Echocardiographic parameters in T-piece weaning trial in respect to T-trial and weaning outcomes_

		SBT-outcome			Weaning Outcome
		Success, n=20	Failure, n=5	P value	Success, n=14	Failure, n=11	P value
Right Ventricular Echocardiography
RVFAC, %	Pre-T	44.2 (2.1)	33.32 (16)	-	46.26 (2.2)	37.32(6.5)	-
RV/LV EDA	Pre-T	0.58 (0.04)	0.38 (0.03)	0.02	0.54 (0.04)	0.54(0.06)	-
RV Sm, cm/sec	Pre-T	16.61 (0.8)	13.25 (0.9)	-	17.08 (0.96)	14.9(0.9)	-
RV Sm, cm/sec	End-T	16.39 (0.9)	14.25 (0.7)	-	16.93 (1.24)	14.9(0.7)	-
RV Em, cm/sec	Pre-T	13.49(1.33)	13.38 (2)	-	14.09 (1.58)	12.3 (1.2)	-
RV Em, cm/sec	End-T	12.33(0.93)	12.37 (0.8)	-	13.39 (1.05)	12.3(1.2)	-
RV Am, cm/sec	Pre-T	17.37 (1.5)	18.97 (2.3)	-	16.8 (1.49)	11 (1)	-
RV Am, cm/sec	End-T	18.27 (1.1)	22.3 (2.43)	-	18.56 (1.23)	19.1 (1.7)	-
RV IVA, m/sec²	Pre-T	5.22 (0.59)	2.97 (0.71)	-	5.76 (0.66)	3.7 (0.5)	0.021
RV IVA, m/sec²	End-T	4.44 (0.65)	3.21 (0.12)	-	4.93 (0.83)	2.9 (0.15)	0.05
RV Tei index	Pre-T	0.66 (0.08)	0.65 (0.15)	-	0.67 (0.1)	0.66(0.1)	-
RV Tei index	End-T	0.79 (1.13)	0.6 (0.05)	-	0.83 (0.18)	0.64(0.1)	-

Left Ventricular Echocardiography
LVEF, %	Pre-T	62.63 (2.1)	58.22 (8.1)	-	63.14 (2.9)	60 (3.7)	-
LV mass, g/m²(Penn)	Pre-T	270 (27)	268 (58)	-	267.9 (39.5)		-
IVSWT, mm	Pre-T	10.8 (0.7)	9.4 (0.6)	-	11 (1)	10 (0.4)	-
LVPWT, mm	Pre-T	9.9 (0.5)	8.7 (0.3)	-	10 (0.7)	9.5 (0.3)	-
LVIDd, mm	Pre-T	45.5 (1)	49.1 (5)	-	44.6 (1.4)	48.2 (1.9)	-
LVIDs, cm	Pre-T	30 (0.7)	34.3 (5.3)		28.7 (0.6)	33.5 (0.2)	0.024
E, cm/sec	Pre-T	72.28 (4.9)	83.3 (8.6)	-	67.18 (3.14)	83.8 (8.3)	0.05
E, cm/sec	End-T	80.71(5.7) *	95.1 (8.9 *	-	76.14(3) *	93.1(10) *	-
A, cm/sec	Pre-T	76.98 (4.8)	88.7 (7.4)		70.31 (4.36)	90.2 (6.2)	0.014
A, cm/sec	End-T	81.63 (5.2)	97.6 (7.8)	-	78.51 (4.76)	93.6 (7.3)	-
DTE, msec	Pre-T	212.4(14.4)	169.5 (27)	-	198.6 (11.7)	211.6(22)	-
DTE, msec	End-T	190.9 (12)	154.8 (24)	-	179.82 (11)	183(19.5)	-
E/A	Pre-T	0.96 (0.05)	0.97 (0.13)	-	0.96 (0.05)	0.95(0.1)	-
E/A	End-T	1 (0.05)	1.02 (0.17)	-	0.99 (0.04)	1(0.1)	-
LV Sm, cm/sec	Pre-T	11.71 (0.6)	10.27 (1.6)	-	11.42 (0.8)	10.3(0.8)	-
LV Sm, cm/sec	End-T	11.94 (0.8)	11.95 (1.4)	-	12.98 (1)	10.7(0.8)	-
LV Em, cm/sec	Pre-T	10.07 (0.7)	9.16 (0.9)	-	10.05 (0.6)	9.5 (1)	-
LV Em, cm/sec	End-T	11.62(0.9) *	11.1 (1.4) *	-	12.1 (1) *	11 (1.3) *	-
LV Am, cm/sec	Pre-T	9.7 (0.4)	12 (0.9)	0.003	10.08 (0.43)	10.6(0.8)	-
LV Am, cm/sec	End-T	11.1 (0.8)	13.24 (1.4)	-	11.22 (1)	11.9 (1)	-
E/Em	Pre-T	7.87 (0.9)	9.56 (1.5)		6.87 (0.35)	9.8 (1.6)	0.05
E/Em	End-T	7.85 (0.1)	9.08 (1.32)	-	6.73 (0.6)	9.72 (1.7)	-
LV IVA, m/sec²	Pre-T	3.58 (0.39)	2.69 (0.37)	-	3.8 (0.47)	2.6 (0.2)	0.046
LV IVA, m/sec²	End-T	3.37 (0.4)	2.67 (0.47)	-	3.8 (0.47)	2.5 (0.36)	0.05
LV Tei index	Pre-T	0.64 (0.06)	0.8 (0.15)	-	0.62 (0.09)	0.72(0.1)	-
LV Tei index	End-T	0.71 (0.11)	0.75 (0.2)	-	0.73 (0.17)	0.7 (0.1)	-

Baseline characteristics of participants according to spontaneous breathing trial outcome_

	Weaning success (N=14)	Weaning failure		P-value

		EWF (<2h) (N=5)	LWF (2-48h) (N=6)
Age, years	58.31 (4.47)	63.25 (2.95)	67.83 (6.84)	0.45

Gender (male)	11 (78.5)	3 (60)	4 (66.7)	0.69

Medical /Surgical critical state	3 (21.5) / 11 (78.5)	2 (40) / 3 (60)	4 (66.7) /2 (33.3)	0.08
Sepsis	3	2	1
Intoxication	0	0	1
Pyelonephritis	0	0	1
Status epilepticus	0	0	1
Peritonitis	0	0	1
Pancreatitis	1	0	0
Neurosurgical	5	2	1
Multiple trauma	2	0	0
Cancer	1	1	0
Hemorrhage	2	0	0

Arterial Hypertension	9 (64.3)	5 (100)	5 (83.3)	0.24
COPD	1 (7)	1 (20)	0	0.46
Diabetes mellitus	3 (21)	1 (20)	0	0.47
APACHE II (on admission)	14.9 (2.66)	18 (4.37)	8.33 (5.84)	0.36
SOFA (on admission)	8.54 (1.64)	7.25 (1.65)	9 (1.46)	0.86
Fluid balance, mL/day	2676 (630)	472 (1667)	2513 (1564)	0.35
Renal dysfunction	3 (21)	2 (40)	2 (33.3)	0.69

T-piece trial
ICU day of SBT	22.79 (6.06)	16 (6)	17.33 (2.65)	0.72
Orotracheal/Tracheostomy tube	11(78) / 3(21)	3(60) / 2(40)	4 (67) / 2(33)	0.69
SOFA	5.3 (0.9)	3.2 (1.1)	3.8 (0.7)	0.38
PaO₂/FIO₂ ratio	370 (31)	281 (78)	392 (36)	0.16
PEEP, cmH₂O	6.3 (0.3)	7 (0.4)	6.7 (0.4)	0.52
f, breaths/min	19.7 (1.8)	24.2 (1.4)	21.1 (1.3)	0.24
V_T, L	0.47 (0.014)	0.46 (0.017)	0.51 (0.026)	0.29
f /V_T (RSBI)	41.7 (3.9)	52.9 (4.7)	42.3 (3.7)	0.20
PFP, cmH₂O_*breaths/min	264 (201)	316 (27)	280 (27)	0.52
MIP, cmH₂O	23.6 (1.57)	23.2 (1.83)	25.71 (1.83)	0.63
BNP, pg/mL	412 (157)	761 (728)	455 (125)	0.70
Albumin, mg/dL	2.7 (0.1)	3 (0.2)	2.8 (0.1)	0.32

PiCCO hemodynamics according to spontaneous breathing trial outcome before (Pre-T) and following (End-T) the trial_

		Weaning success (N=14)	Weaning failure (N=11)	P-value
MAP, mmHg	Pre-T	86.5 (2.6)	95.2 (2.6)	0.02
MAP, mmHg	End-T	91.1 (3.2)	100.4 (6.6)	NS
HR, beats/min	Pre-T	92.1 (4.8)	82.82 (5.2)	NS
HR, beats/min	End-T	95.9 (4.4)	94.0 (57.6)*	NS
RPP, beats_min⁻¹_mmHg	Pre-T	7974 (502)	7985 (603)	NS
RPP, beats_min⁻¹_mmHg	End-T	8786 (550)	9648 (1072)	NS
ScvO₂, %	Pre-T	76.6 (1.7)	74.5 (3)	NS
ScvO₂, %	End-T	79 (1.5)	72.6 (2.5)	0.03
O₂ER, %	Pre-T	22.8 (1.6)	24.4 (2.9)	NS
O₂ER, %	End-T	19.3 (1.5)*	24.3 (2.2)	NS
CVP, mmHg	Pre-T	5.43 (1)	11.27 (1.9)	0.01
CVP, mmHg	End-T	4.86 (0.9)	10.82 (1.6)	0.01
EVLW, mL	Pre-T	430 (20.4)	603 (56)	0.01
EVLW, mL	End-T	440 (30)	566.4 (43)	0.01
ELWI, mL/kg	Pre-T	6.79 (0.7)	9 (0.7)	0.04
ELWI, mL/kg	End-T	6.21 (0.6)	8.54 (0.7)	0.01
CI, L/min/m²	Pre-T	3.82 (0.3)	3.63 (0.3)	NS
CI, L/min/m²	End-T	4.22 (0.3)*	4.25 (0.4)*	NS
SVI, mL/m²	Pre-T	45.3 (3.4)	43.9 (4.8)	NS
SVI, mL/m²	End-T	48.1 (3.3)	47 (4.3)	NS
GEDI, mL/m²	Pre-T	659 (19)	846 (75)	0.013
GEDI, mL/m²	End-T	691 (31)	861 (80)	0.04
PBV, mL	Pre-T	349.3(12.4)	452 (82.6)	NS
PBV, mL	End-T	367.7(15.9)	410 (45.6)	NS
SVRI, cm.d.sec⁻⁵m²	Pre-T	1833 (108)	2122 (199)	NS
SVRI, cm.d.sec⁻⁵m²	End-T	1755 (101)	1924 (222)	NS
dPmx, mmHg/min	Pre-T	1357 (118)	1070 (130)	NS
dPmx, mmHg/min	End-T	1266 (154)	1146 (113)	NS
PVP	Pre-T	1.28 (0.1)	1.65 (0.2)	0.028
PVP	End-T	1.22 (0.1)	1.5 (0.2)	NS
CFI, L/min	Pre-T	5.79 (0.4)	4.58 (0.6)	NS
CFI, L/min	End-T	6.16 (0.4)	5.25 (0.6)	NS
GEF, %	Pre-T	52.2 (3.8)*	42.36 (4)*	NS
GEF, %	End-T	26.7 (0.9)*	23.94 (3)*	NS

Univariate and independent determinants of extravascular lung water index (pre spontaneous breathing trial values)

	Univariate linear regression analysis			Multivariate linear regression analysis
	r	R2	P value	b	B (95%CI)	P value
GEF	−0.481	0.231	0.03	−0.013	−0.003 (−0.024 – 0.019)	NS
LV Sm	−0.487	0.237	0.01	0.004	0.004 (−0.131 – 0.139)	NS
LV E/Em	0.404	0.163	0.04	0.203	0.133 (0.063 – 0.202)	0.01
CVP	0.431	0.185	0.03	−0.041	−0.018 (−0.066 – 0.031)	NS

Weaning Outcome is Associated with ELWI and Impaired Diastolic Function

Figures & Tables

Fig. 1.

Fig. 2.

Echocardiographic parameters in T-piece weaning trial in respect to T-trial and weaning outcomes_

Baseline characteristics of participants according to spontaneous breathing trial outcome_

PiCCO hemodynamics according to spontaneous breathing trial outcome before (Pre-T) and following (End-T) the trial_

Univariate and independent determinants of extravascular lung water index (pre spontaneous breathing trial values)

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