Introduction
Materials and methods
Weaning protocol and definitions
Lung ultrasonography
Statistical analysis
Results
Study population
Prevalence and risk factors for pleural effusion
Variables | Missing values, n (%) | Absolute standardized differences | Odd ratio (95% confidence interval), p value by logistic regression | |
---|---|---|---|---|
Univariate | Multivariable | |||
Age (per year) | 0 | 60.5 | 1.04 (1.02–1.06), p < 0.001 | 1.03 (1.01–1.05), p = 0.017 |
SAPS II (per point) | 0 | 26.9 | 1.02 (1.0–1.03), p = 0.048 | I/NR |
Mc Cabe class II (yes vs. no) | 0 | 51.8 | 4.7 (2.1–10.3), p < 0.001 | 4.2 (1.8–9.9), p = 0.001 |
Cancer or hematological malignancy (yes vs. no) | 0 | 47 | 3.5 (1.7–7.2), p = 0.001 | NI |
Cardiac disease (yes vs. no) | 0 | 55.1 | 3.3 (1.1–3.3), p < 0.001 | 2.2 (1.1–4.4), p = 0.02 |
Left ventricle ejection fraction at cardiac ultrasound (%), | 44 (18%) | 52.9 | 0.96 (0.93–0.98), p < 0.001 | NI |
Supra-ventricular arrhythmias (yes vs. no) | 0 | 35.8 | 2.3 (1.3–4.2), p = 0.007 | NI |
Acute respiratory failure as cause of intubation (yes vs. no) | 0 | 31.9 | 1.9 (1.3–3.9), p = 0.02 | 1.8 (0.98–3.2), p = 0.059 |
Dialysis (yes vs. no) | 0 | 31.5 | 2.5 (1.2–5.4), p = 0.02 | 2.0 (0.9–4.6), p = 0.088 |
Serum Creatinine (per µmol/L) | 0 | 25.8 | 1.0 (0.99–1.00), p = 0.20 | NI |
Septic shock (yes vs. no) | 0 | 25.4 | 1.7 (0.98–2.9), p = 0.06 | I/NR |
ARDS (yes vs. no) | 0 | 22.2 | 1.7 (0.91–3.1), p = 0.098 | I/NR |
Duration of MV before first SBT (per day) | 0 | 19 | 1.04 (0.99–1.1), p = 0.15 | NI |
Outcome of weaning
Variables | Moderate-to-large pleural effusion | p value | |
---|---|---|---|
Absent (n = 168) | Present (n = 81) | ||
Male gender | 98 (58%) | 52 (64%) | 0.38 |
Age (years) | 61 [50–72] | 69 [60–80] | < 0.001 |
SAPS II score at ICU admission | 49 [37–62] | 52 [41–67] | 0.07 |
Comorbidities
| |||
Neurological disease | 22 (13%) | 6 (7%) | 0.18 |
Cardiac disease | 93 (55%) | 65 (80%) | < 0.001 |
Cirrhosis | 12 (7%) | 9 (11%) | 0.29 |
Chronic renal failure | 22 (13%) | 16 (20%) | 0.17 |
Cancer or hematological malignancy | 16 (10%) | 22 (27%) | < 0.001 |
Main reason for intubation
| |||
Coma | 54 (32%) | 9 (11%) | < 0.001 |
Acute respiratory failure | 51 (30%) | 37 (46%) | 0.02 |
Septic shock | 22 (13%) | 12 (15%) | 0.71 |
Others | 41 (24%) | 23 (28%) | 0.5 |
From ICU admission to first SBT
| |||
ARDS | 32 (19%) | 23 (28%) | 0.096 |
Duration of MV before the first SBT | 4 [2–7] | 4 [3–9] | 0.09 |
Dialysis | 15 (9%) | 16 (20%) | 0.015 |
Biological and ultrasound data at first SBT
| |||
Serum creatinine (µmol/L) | 74 [55–119] | 90 [60–164] | 0.07 |
Serum protide (mg/L) | 59 [54–66] | 59 [51–63] | 0.19 |
Bilateral pleural effusion | 16 (10%) | 60 (74%) | < 0.001 |
Maximal interpleural distance (mm) | 0 [0–5] | 27 [20–41] | < 0.001 |
Condensation or atelectasis of lung adjacent to the pleural effusion at ultrasound | – | 68 (84%) | |
Left ventricle ejection fraction (%) | 60 [50–60] | 50 [39–60] | < 0.001 |
Outcome
| |||
Pleural effusion drainage during weaning | 0 | 4 (5%) | 0.005 |
Prophylactic NIV post-extubation | 62 (38%) | 33 (43%) | 0.39 |
Failure of the first SBT | 19 (11%) | 27 (33%) | < 0.001 |
Extubation failure | 24 (15%) | 15 (20%) | 0.31 |
Weaning failurea | 36 (22%) | 37 (47%) | < 0.001 |
Weaning groupb | 0.03 | ||
Short weaning | 118 (70%) | 43 (53%) | |
Difficult weaning | 38 (20%) | 26 (32%) | |
Prolonged weaning | 16 (10%) | 12 (15%) | |
Tracheotomy | 4 (2%) | 2 (3%) | 0.97 |
VFD from first SBT to day 28 (days) | 23 [16–26] | 21 [5–24] | 0.01 |
Death in ICU | 14 (8%) | 13 (16%) | 0.07 |
Death at day 28 | 14 (8%) | 14 (17%) | 0.04 |
Variables | Weaning success (n = 173) | Weaning failure (n = 73) | p value |
---|---|---|---|
Male gender | 98 (57%) | 49 (67%) | 0.13 |
Age (years) | 61 [52–73] | 69 [60–79] | 0.006 |
Body mass index (kg/m2) | 26 [22–29] | 27 [22–32] | 0.07 |
SAPS II at ICU admission | 49 [38–62] | 49 [39–65] | 0.73 |
Comorbidities
| |||
COPD | 23 (13%) | 23 (32%) | 0.001 |
Cardiac disease | 101 (58%) | 55 (75%) | 0.01 |
Main reason for intubation
| |||
Coma | 54 (31%) | 9 (12%) | 0.002 |
Acute respiratory failure | 48 (27%) | 39 (53%) | < 0.001 |
Septic shock | 24 (14%) | 8 (11%) | 0.54 |
Others | 47 (27%) | 17 (23%) | 0.53 |
From ICU admission to first SBT
| |||
ARDS | 28 (16%) | 27 (37%) | < 0.001 |
Neuromuscular blockade | 26 (15%) | 28 (38%) | < 0.001 |
Septic shock | 61 (35%) | 39 (53%) | 0.01 |
VAP | 17 (10%) | 16 (22%) | 0.01 |
Supra-ventricular arrhythmias | 32 (19%) | 22 (30%) | 0.04 |
Duration of MV before first SBT | 3 [2–6] | 6 [3–12] | < 0.001 |
Dialysis | 22 (13%) | 8 (11%) | 0.70 |
Fluid balance between ICU admission and first SBT (L) | 2.8 [0.9–6.4] | 5.7 [0.7–11.4] | 0.01 |
Biological and ultrasound data at first SBT
| |||
PaO2/FiO2 ratio (mmHg) | 307 [242–385] | 247 [200–299] | < 0.001 |
Moderate-to-large pleural effusion | 42 (24%) | 37 (51%) | < 0.001 |
Drainable pleural effusion | 36 (21%) | 29 (40%) | 0.002 |
Large pleural effusion | 21 (12%) | 25 (34%) | < 0.001 |
Left ventricle ejection fraction (%, n = 205) | 60 [50–60] | 55 [40–60] | 0.06 |
Outcome
| |||
Pleural effusion drainage during weaning | 0 | 4 (6%) | 0.01 |
Prophylactic NIV post-extubation | 65 (38%) | 30 (44%) | 0.35 |
Tracheotomy | 1 (1%) | 5 (7%) | 0.01 |
VFD from first SBT to day 28 (days) | 23 [20–26] | 11 [0–21] | < 0.001 |
Death in ICU | 5 (3%) | 19 (26%) | < 0.001 |
Death at day 28 | 8 (5%) | 17 (23%) | < 0.001 |
Variables | Missing values, n (%) | Absolute standardized differences | Odd ratio (95% confidence interval), p value by logistic regression | |
---|---|---|---|---|
Univariate | Multivariable | |||
Age (per year) | 0 | 47 | 1.03 (1.01–1.05), p = 0.01 | 1.02 (0.997–1.05), p = 0.08 |
Body mass index (per kg/m2) | 6 (2%) | 32 | 1.06 (1.01–1.11), p = 0.02 | I/NR |
COPD (yes vs. no) | 0 | 48 | 3.0 (1.6–5.8), p = 0.001 | 2.2 (1.02–4.7), p = 0.045 |
Cardiac disease (yes vs. no) | 0 | 37 | 2.2 (1.2–4.0), p = 0.01 | I/NR |
Left ventricle ejection fraction at cardiac ultrasound (%) | 44 (18%) | 27 | 0.98 (0.96–1.0), p = 0.09 | NI |
Supra–ventricular arrhythmias (yes vs. no) | 0 | 26 | 1.9 (1.01–3.6), p = 0.046 | NI |
Septic shock (yes vs. no) | 0 | 37 | 2.1 (1.2–3.7), p = 0.01 | I/NR |
Fluid balance between ICU admission and first SBT (per L) | 15 (6%) | 44 | 1.07 (1.03–1.12), p = 0.002 | NI |
Acute respiratory failure as cause of intubation (yes vs. no) | 0 | 55 | 3.0 (1.7–5.2), p < 0.001 | NI |
PaO2/FiO2 ratio (per mmHg) | 3 (1%) | 58 | 0.994 (0.991–0.997), p < 0.001 | 0.996 (0.993–1.0), p = 0.03 |
Duration of MV before the first SBT (per day) | 0 | 57 | 1.11 (1.06–1.17), p < 0.001 | 1.11 (1.05–1.17), p < 0.001 |
ARDS before the first SBT (yes vs. no) | 0 | 49 | 3.0 (1.6–5.7), p < 0.001 | NI |
Neuromuscular blockade before the first SBT (yes vs. no) | 0 | 54 | 3.5 (1.9–6.6), p < 0.001 | NI |
VAP before the first SBT (yes vs. no) | 0 | 33 | 2.6 (1.2–5.4), p = 0.01 | NI |
Moderate-to-large pleural effusion (yes vs. no) | 0 | 58 | 3.2 (1.8–5.7), p < 0.001 | 3.0 (1.5–5.8), p = 0.001 |