Left ventricular overloading identified by critical care echocardiography is key in weaning-induced pulmonary edema.

ABSTRACT: PURPOSE:To assess the role of left ventricular overload and cumulated fluid balance in the development weaning-induced pulmonary edema (WIPO). METHODS:Ventilated patients in sinus rhythm with COPD and/or heart failure (ejection fraction???40%) were studied. Echocardiography was performed immediately before and during a 30-min spontaneous breathing trial (SBT) using a T-tube. Patients who failed were treated according to echocardiography results before undergoing a second SBT. RESULTS:Twelve of 59 patients failed SBT, all of them developing WIPO. Patients who succeeded SBT had lower body weight (-?2.5 kg [-?4.8; -?1] vs.?+?0.75 kg [-?2.95; ?+?5.57]: p?=?0.02) and cumulative fluid balance (-?2326 ml [-?3715; ?+?863] vs.?+?143 ml [-?2654;?+?4434]: p?=?0.007) than those who developed WIPO. SBT-induced central hemodynamic changes were more pronounced in patients who developed WIPO, with higher E wave velocity (122 cm/s [92; 159] vs. 93 cm/s [74; 109]: p?=?0.017) and E/A ratio (2.1 [1.2; 3.6] vs. 0.9 [0.8; 1.4]: p?=?0.001), and shorter E wave deceleration time (85 ms [72; 125] vs. 147 ms [103; 175]: p?=?0.004). After echocardiography-guided treatment, all patients who failed the first SBT were successfully extubated. Fluid balance was then negative (-?2224 ml [-?7056;?+?100] vs.?+?146 ml [-?2654;?+?4434]: p?=?0.005). Left ventricular filling pressures were lower (E/E': 7.3 [5; 10.4] vs. 8.9 [5.9; 13.1]: p?=?0.028); SBT-induced increase in E wave velocity (+?10.6% [-?2.7/?+?18] vs.?+?25.6% [+?12.7/?+?49]: p?=?0.037) and of mitral regurgitation area were significantly smaller. CONCLUSION:In high-risk patients, WIPO appears related to overloaded left ventricle associated with excessive fluid balance. SBT-induced central hemodynamic changes monitored by CCE help in guiding therapy for successful weaning.

SUBMITTER: Goudelin M 

PROVIDER: S-EPMC7223421 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature