Background
Methods
Study population
Study protocol
Classification of weaning
Echocardiography
Statistical analysis
Results
Patient population, cardiac function and weaning outcome
All patients (n = 67) | Weaning |
p
| ||
---|---|---|---|---|
Short (n = 49) | Prolonged (n = 18) | |||
Patient characteristics
| ||||
Age, year | 64 (47–76) | 61 (49–75) | 69 (44–81) | 0.50 |
Male sex | 44 (66) | 31 (63) | 13 (72) | 0.49 |
SAPS II at ICU admission | 46 (34–53) | 44 (34–58) | 46 (34–50) | 0.50 |
Comorbidities
| ||||
Hypertension | 33 (49) | 23 (47) | 10 (56) | 0.52 |
Diabetes | 17 (26) | 9 (19) | 8 (44) | 0.05 |
Chronic obstructive pulmonary disease | 17 (25) | 13 (27) | 4 (22) | > 0.99 |
History of ischemic heart disease | 13 (19) | 11 (22) | 2 (11) | 0.48 |
Atrial fibrillation | 22 (33) | 13 (27) | 9 (50) | 0.07 |
Reason for intubation
| 0.67 | |||
Coma | 13 (19) | 9 (18) | 4 (22) | |
Septic shock | 8 (12) | 5 (10) | 3 (17) | |
Cardiogenic pulmonary edema | 17 (25) | 14 (29) | 3 (17) | |
Pneumonia | 18 (27) | 12 (25) | 6 (33) | |
Cardiac arrest | 4 (6) | 4 (8) | 0 (0) | |
Surgery | 7 (10) | 5 (10) | 2 (11) | |
Events between ICU admission and inclusion
| ||||
Septic shock | 33 (49) | 25 (51) | 8 (44) | 0.63 |
Ventilator-associated pneumonia | 15 (22) | 9 (18) | 6 (33) | 0.21 |
Acute respiratory distress syndrome | 26 (39) | 18 (37) | 8 (44) | 0.56 |
Use of neuromuscular blockers | 11 (16) | 9 (18) | 2 (11) | 0.71 |
Cumulative fluid balance before inclusion, mL | 4322 (949–7898) | 4322 (175–7253) | 4228 (1757–17,957) | 0.27 |
Duration of invasive MV before inclusion, days | 3 (2–6) | 3 (2–6) | 5 (3–13) | 0.08 |
Clinical and biological data at inclusion
| ||||
SOFA score | 4 (3–6) | 4 (3–6) | 5 (4–6) | 0.25 |
Systolic arterial pressure, mmHg | 129 (122–144) | 132 (113–146) | 127 (108–136) | 0.44 |
Heart rate, beats/min | 93 (82–105) | 93 (83–106) | 91 (79–104) | 0.60 |
Respiratory rate, beats/min | 25 (19–30) | 23 (18–29) | 29 (27–33) | 0.06 |
RPP, beats/min·mmHg | 12,500 (11,288–15,346) | 12,576 (10,744–15,520) | 12,423 (12,245–13,035) | > 0.99 |
Arterial blood gases | ||||
pH, units | 7.44 (7.40–7.47) | 7.44 (7.40–7.47) | 7.44 (7.41–7.47) | 0.77 |
PaO2/FiO2 ratio, mmHg | 210 (182–270) | 222 (188–277) | 186 (153–226) | < 0.01 |
PaCO2, mmHg | 41 (35–46) | 40 (35–46) | 42 (37–49) | 0.42 |
BNP, pg/ml | 331 (114–602) | 302 (108–588) | 415 (114–842) | 0.51 |
Protidemia, g/L | 58 (51–66) | 58 (54–66) | 54 (49–66) | 0.39 |
Creatinine, micromol/L | 79 (57–101) | 81 (59–98) | 73 (55–107) | 0.96 |
Randomization in the interventional group | 34 (51) | 25 (51) | 9 (50) | 0.94 |
Echocardiographic variables
| ||||
LVEF, % | 55 (40–60) | 50 (37–60) | 60 (50–62) | 0.26 |
Cardiac index, L/min/m2 | 3.0 (2.2–3.6) | 3.1 (2.3–3.6) | 2.7 (2.1–3.7) | 0.52 |
Systolic dysfunction
| ||||
LVEF < 50% | 25 (37) | 21 (43) | 4 (22) | 0.12 |
Diastolic dysfunction
a
| ||||
LVEF ≥ 50% and BNP > 35 pg/mL and (E/e′ ratio ≥ 13 or e′ < 9) | 11 (17) | 4 (8) | 7 (39) | 0.01 |
Heart valve diseaseb | 23 (34) | 14 (29) | 9 (50) | 0.10 |
RV/LV area ratio | 0.6 (0.5–0.7) | 0.6 (0.4–0.7) | 0.6 (0.5–0.7) | 0.67 |
Tricuspid annular plane systolic excursion, cm | 1.9 (1.5–2.6) | 2.1 (1.7–2.7) | 1.5 (1.3–1.9) | 0.03 |
Systolic pulmonary artery pressure, mmHg | 38 (25–51) | 37 (25–49) | 46 (25–66) | 0.16 |
All patients (n = 67) | Weaning |
p
| ||
---|---|---|---|---|
Short (n = 49) | Prolonged (n = 18) | |||
Cardiovascular treatments during weaning
| ||||
Diuretics | 56 (84) | 38 (78) | 18 (100) | 0.03 |
Dobutamine | 19 (28) | 15 (31) | 4 (22) | 0.50 |
Vasodilator | 30 (45) | 26 (53) | 4 (22) | 0.02 |
Amiodarone | 19 (28) | 13 (27) | 6 (33) | 0.58 |
Any cardiovascular treatment | 62 (93) | 44 (90) | 18 (100) | 0.31 |
Average daily furosemide dose during weaning, mg | 25 (4–59) | 30 (1–59) | 22 (6–56) | 0.94 |
Average daily fluid balance during weaning, mL | − 757 (− 2016 to − 81) | − 1202 (− 2342 to − 477) | 51 (− 638 to 449) | < 0.01 |
Average daily urine output during weaning, mL | 2588 (1971 to 3863) | 2950 (2205 to 4167) | 1967 (1649 to 2912) | 0.02 |
Outcomes
| ||||
Time to first successful extubation, days | 2 (1–6) | 1 (1–2) | 13 (10–32) | < 0.01 |
Ventilator free days at day-28, days | 24 (18–27) | 27 (25–27) | 0 (0–16) | < 0.01 |
Time to discharge from ICU, days | 9 (5–18) | 7 (4–10) | 31 (15–53) | < 0.01 |
Time to discharge from hospital, days | 28 (15–53) | 22 (13–32) | 39 (22–53) | 0.07 |
ICU mortality | 9 (13) | 2 (4) | 7 (39) | < 0.01 |
Hospital mortality | 10 (15) | 3 (6) | 7 (39) | < 0.01 |
Dynamics of LV contractility and relaxation during weaning trials
All n = 31 | Success n = 16 | Failure n = 15 |
p
| |
---|---|---|---|---|
Delta s′a | − 3% (− 12%; 9%) | − 3% (− 7%; 5%) | − 2% (− 15%; 9%) | 0.872 |
Delta e′ | − 3% (− 12%; − 4%) | 3% (− 9%; 6%) | − 6% (− 18%; − 3%) | 0.02 |
Delta E | 13% (8%; 19%) | 12% (7%; 16%) | 14% (11%; 23%) | 0.20 |
Delta E/e′ | 16% (9%; 25%) | 10% (4%; 14%) | 26% (20%; 28%) | < 0.01 |