Critical
Care volume 29, Article number: 140 (2025) Published: 31
March 2025
Background
During the weaning process, the transition from positive to
negative pressure ventilation may induce cardiac dysfunction, which may lead to
pulmonary oedema. The incidence of weaning-induced pulmonary oedema (WIPO) is
poorly documented and shows huge variations. Our study aims to investigate the
incidence and risk factors for WIPO during weaning from mechanical ventilation
in general critically ill patients.
Methods
This multicentre study was conducted in France, Italy, and
India. Adult critically ill patients receiving invasive ventilation were
included once a spontaneous breathing trial (SBT) was performed. The SBT
technique could be either T-piece or pressure support mode with (PSV-PEEP) or
without positive end expiratory pressure (PEEP) (PSV-ZEEP). A consensual
diagnosis of WIPO was made a posteriori by five experts who analysed changes
observed during the SBT that were retrospectively recorded.
Results
From July 2019 to February 2021, 634 SBTs were performed in
500 patients from 13 ICUs. Weaning success occurred in 417 patients (66%) and
weaning failure in 217 (34%). Weaning was short in 414 (83%) of SBTs, difficult
in 47 (9%) SBTs, and prolonged in 39 (8%) SBTs. WIPO was diagnosed in 79 (12%)
cases, which accounted for 36% of the 217 weaning failures. WIPO occurred in
54/358 (15%) of T-piece SBT, in 7/84 (8%) of PSV-PEEP SBT (p = 0.072 vs. T-piece), and in 18/192 (9%) of PSV-ZEEP SBT (p = 0.002 vs. T-piece). In multilevel logistic regression
analysis including 202 weaning failures from 149 different patients, COPD, and
previous cardiomyopathy were identified as independent risk factors associated
with WIPO.
Conclusion
In general ICU patients, WIPO accounts for 36% of weaning
failure cases. Previous heart disease and COPD are two independent risk factors
for developing WIPO during the weaning process.
No comments:
Post a Comment