Background
Methods
Study population
Second SBT and weaning outcomes
Definition of WiPO
Echocardiography
Biomarkers
Definition of WiCI
Statistical analysis
Results
Patient population
Clinical and biological data | All patients (n = 208) | Weaning outcome |
p
| ||
---|---|---|---|---|---|
Short (n = 51) | Difficult (n = 95) | Prolonged (n = 62) | |||
Clinical data | |||||
Body weight, kg | 78 (66–95) | 81 (68–90) | 78 (66–96) | 78 (65–92) | 0.962 |
Variation of weight since admission, kg | 0 (−2 to 4) | 0 (−2 to 4) | 0 (−1 to 3) | 1 (−2 to 5) | 0.965 |
SOFA score | 3 (3–5) | 3 (2–4) | 3 (3–5) | 4 (3–6) | 0.130 |
Richmond Agitation-Sedation Score | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0.230 |
Temperature, °C | 37.8 (37.5–38.2) | 37.8 (37.5–38.2) | 37.7 (37.3–38.2) | 37.7 (37.4–38.1) | 0.745 |
Fluid balance since admission, ml | 4500 (1677–10,966) | 3471 (737–6498) | 4161 (1052–9654) | 8653 (2838–15,121) | 0.002 |
Use of diuretics since admission | 111 (53.4) | 26 (51.0) | 48 (50.5) | 37 (59.7) | 0.492 |
Spontaneous cough | 155 (76.0) | 43 (86.0) | 69 (73.4) | 43 (71.7) | 0.130 |
Delirium (CAM-ICU) | 70 (33.6) | 16 (31.4) | 32 (33.7) | 22 (35.5) | 0.915 |
New or persistent radiological pulmonary consolidation | 58 (28.3) | 14 (28.6) | 20 (21.1) | 24 (39.3) | 0.047 |
Duration of mechanical ventilation since intubation | 6 (4–13) | 6 (3–8) | 6 (3–9) | 13 (7–20) | < 0.001 |
Mechanical ventilation | 0.013 | ||||
Assist-control ventilation | 35 (16.9) | 5 (9.8) | 13 (13.8) | 17 (27.4) | |
Pressure support ventilation | 170 (82.1) | 46 (90.2) | 81 (86.2) | 43 (69.4) | |
Others | 2 (1.0) | 0 (0.0) | 0 (0.0) | 2 (3.2) | |
Heat and moisture exchanger | 141 (68.4) | 31 (60.8) | 65 (69.9) | 45 (72.6) | 0.374 |
Pressure support level, cmH2O | 12 (10–14) | 12 (10–13) | 12 (10–14) | 12 (10–14) | 0.229 |
PEEP, cmH2O | 5 (5–6) | 5 (5–5) | 5 (5–6) | 5 (5–5) | 0.362 |
Tidal volume, ml | 438 (376–499) | 434 (359–479) | 443 (380–512) | 430 (378–472) | 0.553 |
Tidal volume per kilogram body weight, mL/kg | 7.1 (6.2–8.1) | 7.0 (6.3–8.3) | 7.3 (6.3–8.2) | 6.7 (6.1–7.9) | 0.453 |
Respiratory rate, breaths per minute | 26 (20–31) | 27 (19–32) | 25 (21–29) | 26 (20–31) | 0.804 |
Number of tracheal suctions during 24 h | 7 (5–11) | 8 (6–10) | 8 (5–12) | 6 (4–11) | 0.424 |
MRC muscle scale | 50 (9–60) | 60 (40–60) | 52 (20–60) | 25 (5–48) | 0.002 |
Biological data | |||||
White blood count, G/l | 11.4 (8.3–15.2) | 11.1 (7.9–13.4) | 11.8 (8.9–15.1) | 12.4 (7.8–16.9) | 0.460 |
Creatinine, micromol/l | 78 (53–140) | 82 (58–121) | 77 (52–142) | 75 (52–147) | 0.761 |
Protid, g/l | 59 (54–65) | 59 (55–66) | 57 (53–64) | 61 (55–66) | 0.224 |
Hemoglobin, g/dl | 9.4 (8.2–10.8) | 9.6 (8.3–11.2) | 9.6 (8.4–10.8) | 9.0 (7.9–10.1) | 0.042 |
Positive lower respiratory tract sample | 30 | 9 | 10 | 11 | 0.341 |
Time since intubation, days | 6 (4–13) | 6 (3–8) | 6 (3–9) | 13 (7–20) | < 0.001 |
Type of the second SBT | 0.455 | ||||
T-piece | 204 (98.1) | 51 (100.0) | 93 (97.9) | 60 (96.8) | |
Pressure support ventilation without PEEP | 4 (2.0) | 0 (0.0) | 2 (2.1) | 2 (3.2) | |
Duration of the second SBT, minutes | 60 (17–120) | 120 (55–123) | 50 (18–120) | 24 (10–97) | < 0.001 |
Failure of the second SBT | 132 (63.5) | 16 (31.4) | 68 (71.6) | 48 (77.4) | < 0.001 |
Reasons for second SBT failurea | |||||
Respiratory rate > 35/min | 89 (65.4) | 10 (58.8) | 43 (61.4) | 36 (73.5) | 0.329 |
SpO2 < 90% | 47 (34.6) | 6 (35.3) | 25 (35.7) | 16 (32.7) | 0.940 |
PCO2 > 50 mmHg | 9 (6.6) | 0 (0.0) | 8 (11.4) | 1 (2.0) | 0.064 |
Heart rate > 140/min | 4 (2.9) | 0 (0.0) | 2 (2.9) | 2 (4.1) | 0.691 |
Systolic arterial pressure > 180 mmHg | 21 (15.4) | 2 (11.8) | 10 (14.3) | 9 (18.4) | 0.752 |
Increased work of breathing or distress | 68 (50.0) | 8 (47.1) | 33 (47.1) | 27 (55.1) | 0.671 |
Alteration of consciousness | 6 (4.4) | 0 (0.0) | 1 (1.4) | 5 (10.2) | 0.046 |
Second SBT
Biological and echocardiographic data | Before | At the end |
p
|
---|---|---|---|
Success (n = 76) | |||
Troponin T, ng/l | 297 (926) | 303 (969) | 0.641 |
NT-proBNP, ng/l | 4166 (7316) | 3975 (6632) | 0.159 |
Protein, g/l | 59.1 (10.9) | 60.4 (10.1) | 0.040 |
E mitral wave, cm/s | 87.4 (24.4) | 89.9 (26.7) | 0.248 |
E/A ratio | 0.99 (0.39) | 1.00 (0.52) | 0.736 |
E/e’ ratio | 10.6 (5.7) | 10.7 (5.4) | 0.778 |
LVEF, % | 52 (15) | 53 (14) | 0.323 |
CO, l/min | 5.9 (1.8) | 6.2 (2.0) | 0.225 |
Failure (n = 132) | |||
Troponin T, ng/l | 410 (1866) | 418 (1921) | 0.326 |
NT-proBNP, ng/l | 5726 (14509) | 5983 (15476) | 0.015 |
Protein, g/l | 59.8 (9.1) | 62.0 (9.0) | < 0.001 |
E mitral wave, cm/s | 88.6 (33.7) | 101.9 (36.0) | < 0.001 |
E/A ratio | 1.04 (0.54) | 1.18 (0.61) | 0.003 |
E/e’ ratio | 11.1 (6.7) | 11.8 (6.9) | 0.040 |
LVEF, % | 54 (14) | 55 (15) | 0.048 |
CO, l/min | 5.7 (2.0) | 6.1 (2.2) | 0.012 |
WiPO | All patients (n = 208) | Second SBT |
p
| Weaning outcome |
p
| |||
Success (n = 76) | Failure (n = 132) | Simple (n = 51) | Difficult (n = 95) | Prolonged (n = 62) | ||||
Liberal definition | 124 (59.6) | 35 (46.1) | 89 (67.4) | 0.002 | 30 (58.8) | 54 (56.8) | 40 (64.5) | 0.626 |
Conservative definition | 44 (21.2) | 9 (11.8) | 35 (26.5) | 0.013 | 8 (15.7) | 22 (23.2) | 14 (22.6) | 0.524 |
WiCI | All patients (n = 177) | Second SBT |
p
| Weaning outcome |
p
| |||
Success (n = 64) | Failure (n = 113) | Simple (n = 43) | Difficult (n = 83) | Prolonged (n = 51) | ||||
ESC 2012 | 36 (20.3) | 13 (20.3) | 23 (20.4) | 0.995 | 8 (18.6) | 15 (18.1) | 13 (25.5) | 0.555 |
AHA 2013 | 12 (6.8) | 3 (4.7) | 9 (8.0) | 0.540 | 0 (0.0) | 5 (6.0) | 7 (13.7) | 0.029 |
WiCI | WiPO (liberal definition) |
p
| WiPO (conservative definition) |
p
| ||
---|---|---|---|---|---|---|
No (n = 73) | Yes (n = 104) | No (n = 141) | Yes (n = 36) | |||
ESC 2012 | 11 (15.1) | 25 (24.0) | 0.144 | 26 (18.4) | 10 (27.8) | 0.214 |
AHA 2013 | 6 (8.2) | 6 (5.8) | 0.555 | 11 (7.8) | 1 (2.8) | 0.464 |