weaning | The Journal of Critical Care Medicine

Weaning Outcome is Associated with ELWI and Impaired Diastolic Function

Dimitra Bagka¹, George Zakynthynos², Vasiliki Tsolaki¹, Jonh Papanikolaou³, Vasilis Vazgiourakis¹, Maria Baka¹, Konstantinos Pratsas¹, Demosthenes Makris¹

1 General University Hospital of Larissa, Larisa, Greece
2 University of Athens, Athens, Greece
3 General Hospital of Trikala, Greece

DOI: 10.2478jccm-2024-0008

Objectives: To evaluate hemodynamic profiles of critical care patients undergoing spontaneous t-piece trial (SBT) and present weaning failure.
Methods: Prospective observational study conducted in ready-to-wean non-cardiac ICU patients. Clinical, echocardiographic and thermodilution-derived variables were recorded before and after a 2-hour SBT. Weaning from mechanical ventilation was defined as preservation of spontaneous breathing for 48 hours following successful SBT.
Results: Fourteen patients succeeded weaning, five manifested T-trial-failure and six late-failure. Weaning outcome was significantly associated with ELWI(Extravascular lung-water index), global-end-diastolic index and impaired diastolic function, as indicated by pre-T Doppler early wave velocities (E/Em); Fifty-six percent of participants presented ELWI≥7mL/kg when fulfilling predetermined criteria for weaning. ELWI, impaired pulmonary permeability and left ventricular diastolic dysfunction were independent determinants of ELWI.
Conclusions: ELWI before SBT and impaired diastolic function (as indicated by pre-T E/Em) might be weaning outcome determinants and their assessment may allow better risk stratification in weaning decision making.

Risk Factors for Weaning Failure in COVID-19 Patients

Effrosyni Gerovasileiou¹, Apostolis-Alkiviadis Menis², George Gavriilidis³, Eleni Magira⁴, Prodromos Temperikidis⁵, Sofia Papoti², Nikitas Karavidas¹, Michael Spanos¹, Epaminondas Zakynthinos⁶, Demosthenes Makris¹

1 University Hospital of Larissa, Larissa, Greece
2 G. Papanikolaou Hospital, Thessaloniki, Greece
3 Sotiria Regional Chest Disease Hospital of Athens, Athens, Greece
4 Evangelismos Athens General Hospital, Athens, Greece
5 Evangelismos Athens General Hospital, Cardiology, Athens, Greece
6 General University Hospital of Larissa, Larissa, Greece

DOI: 10.2478/jccm-2023-0021

Background: Data on risk factors associated with mechanical ventilation (MV) weaning failure among SARS-CoV2 ARDS patients is limited. We aimed to determine clinical characteristics associated with weaning outcome in SARS-CoV2 ARDS patients under MV.
Objectives: To determine potential risk factors for weaning outcome in patients with SARS-CoV2 ARDS.
Methods: A retrospective observational study was conducted in the ICUs of four Greek hospitals via review of the electronic medical record for the period 2020-2021. All consecutive adult patients were screened and were included if they fulfilled the following criteria: a) age equal or above 18 years, b) need for MV for more than 48 hours and c) diagnosis of ARDS due to SARS-CoV2 pneumonia or primary or secondary ARDS of other aetiologies. Patient demographic and clinical characteristics were recorded for the first 28 days following ICU admission. The primary outcome was weaning success defined as spontaneous ventilation for more than 48 hours.
Results: A hundred and fifty eight patients were included; 96 SARS-CoV2 ARDS patients. SOFA score, Chronic Obstructive Pulmonary Disease (COPD) and shock were independently associated with the weaning outcome OR(95% CI), 0.86 (0.73-0.99), 0.27 (0.08-0.89) and 0.30 (0.14-0.61), respectively]. When we analysed data from SARS-CoV2 ARDS patients separately, COPD [0.18 (0.03-0.96)] and shock [0.33(0.12 – 0.86)] were independently associated with the weaning outcome.
Conclusions: The presence of COPD and shock are potential risk factors for adverse weaning outcome in SARS-CoV2 ARDS patients.