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Weaning Outcome is Associated with ELWI and Impaired Diastolic Function

Dimitra Bagka
Dimitra Bagka
, 
George Zakynthynos
George Zakynthynos
, 
Vasiliki Tsolaki
Vasiliki Tsolaki
, 
Jonh Papanikolaou
Jonh Papanikolaou
, 
Vasilis Vazgiourakis
Vasilis Vazgiourakis
, 
Maria Baka
Maria Baka
, 
Konstantinos Pratsas
Konstantinos Pratsas
 y 
Demosthenes Makris
Demosthenes Makris
   | 30 ene 2024
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Article Category: Research Article
Publicado en línea: 30 ene 2024
Páginas: 64 - 72
Recibido: 27 abr 2023
Aceptado: 29 oct 2023
DOI: https://doi.org/10.2478/jccm-2024-0008
Palabras clave
© 2024 Dimitra Bagka et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1.

Extravascular lung water index (EVLWI) and E/Tissue Doppler Imaging early diastolic velocity (E/Em) in patients undergoing a spontaneous breathing trial before (Pre SBT) and following (End SBT) the trial, according to trial outcome (Median values, inter-quartile range and 10–90th percentiles are presented).
Extravascular lung water index (EVLWI) and E/Tissue Doppler Imaging early diastolic velocity (E/Em) in patients undergoing a spontaneous breathing trial before (Pre SBT) and following (End SBT) the trial, according to trial outcome (Median values, inter-quartile range and 10–90th percentiles are presented).

Fig. 2.

Stroke Volume Index (SVI) against central venous pressure (CVP) plot and Frank Starling curve representations in participants during spontaneous breathing and mechanical ventilation. Open circles represent successful weaning, closed circles represent weaning failure; SB-FSc=Frank-Starling’s curve at spontaneous breathing; MV-FSc= Frank-Starling’s curve during mechanical ventilation.
Stroke Volume Index (SVI) against central venous pressure (CVP) plot and Frank Starling curve representations in participants during spontaneous breathing and mechanical ventilation. Open circles represent successful weaning, closed circles represent weaning failure; SB-FSc=Frank-Starling’s curve at spontaneous breathing; MV-FSc= Frank-Starling’s curve during mechanical ventilation.

Echocardiographic parameters in T-piece weaning trial in respect to T-trial and weaning outcomes.

SBT-outcome Weaning Outcome
Success, n=20 Failure, n=5 P value Success, n=14 Failure, n=11 P value
Right Ventricular Echocardiography
RVFAC, % Pre-T 44.2 (2.1) 33.32 (16) - 46.26 (2.2) 37.32(6.5) -
RV/LV EDA Pre-T 0.58 (0.04) 0.38 (0.03) 0.02 0.54 (0.04) 0.54(0.06) -
RV Sm, cm/sec Pre-T 16.61 (0.8) 13.25 (0.9) - 17.08 (0.96) 14.9(0.9) -
End-T 16.39 (0.9) 14.25 (0.7) - 16.93 (1.24) 14.9(0.7) -
RV Em, cm/sec Pre-T 13.49(1.33) 13.38 (2) - 14.09 (1.58) 12.3 (1.2) -
End-T 12.33(0.93) 12.37 (0.8) - 13.39 (1.05) 12.3(1.2) -
RV Am, cm/sec Pre-T 17.37 (1.5) 18.97 (2.3) - 16.8 (1.49) 11 (1) -
End-T 18.27 (1.1) 22.3 (2.43) - 18.56 (1.23) 19.1 (1.7) -
RV IVA, m/sec2 Pre-T 5.22 (0.59) 2.97 (0.71) - 5.76 (0.66) 3.7 (0.5) 0.021
End-T 4.44 (0.65) 3.21 (0.12) - 4.93 (0.83) 2.9 (0.15) 0.05
RV Tei index Pre-T 0.66 (0.08) 0.65 (0.15) - 0.67 (0.1) 0.66(0.1) -
End-T 0.79 (1.13) 0.6 (0.05) - 0.83 (0.18) 0.64(0.1) -
Left Ventricular Echocardiography
LVEF, % Pre-T 62.63 (2.1) 58.22 (8.1) - 63.14 (2.9) 60 (3.7) -
LV mass, g/m2(Penn) Pre-T 270 (27) 268 (58) - 267.9 (39.5) -
IVSWT, mm Pre-T 10.8 (0.7) 9.4 (0.6) - 11 (1) 10 (0.4) -
LVPWT, mm Pre-T 9.9 (0.5) 8.7 (0.3) - 10 (0.7) 9.5 (0.3) -
LVIDd, mm Pre-T 45.5 (1) 49.1 (5) - 44.6 (1.4) 48.2 (1.9) -
LVIDs, cm Pre-T 30 (0.7) 34.3 (5.3) 28.7 (0.6) 33.5 (0.2) 0.024
E, cm/sec Pre-T 72.28 (4.9) 83.3 (8.6) - 67.18 (3.14) 83.8 (8.3) 0.05
End-T 80.71(5.7) * 95.1 (8.9 * - 76.14(3) * 93.1(10) * -
A, cm/sec Pre-T 76.98 (4.8) 88.7 (7.4) 70.31 (4.36) 90.2 (6.2) 0.014
End-T 81.63 (5.2) 97.6 (7.8) - 78.51 (4.76) 93.6 (7.3) -
DTE, msec Pre-T 212.4(14.4) 169.5 (27) - 198.6 (11.7) 211.6(22) -
End-T 190.9 (12) 154.8 (24) - 179.82 (11) 183(19.5) -
E/A Pre-T 0.96 (0.05) 0.97 (0.13) - 0.96 (0.05) 0.95(0.1) -
End-T 1 (0.05) 1.02 (0.17) - 0.99 (0.04) 1(0.1) -
LV Sm, cm/sec Pre-T 11.71 (0.6) 10.27 (1.6) - 11.42 (0.8) 10.3(0.8) -
End-T 11.94 (0.8) 11.95 (1.4) - 12.98 (1) 10.7(0.8) -
LV Em, cm/sec Pre-T 10.07 (0.7) 9.16 (0.9) - 10.05 (0.6) 9.5 (1) -
End-T 11.62(0.9) * 11.1 (1.4) * - 12.1 (1) * 11 (1.3) * -
LV Am, cm/sec Pre-T 9.7 (0.4) 12 (0.9) 0.003 10.08 (0.43) 10.6(0.8) -
End-T 11.1 (0.8) 13.24 (1.4) - 11.22 (1) 11.9 (1) -
E/Em Pre-T 7.87 (0.9) 9.56 (1.5) 6.87 (0.35) 9.8 (1.6) 0.05
End-T 7.85 (0.1) 9.08 (1.32) - 6.73 (0.6) 9.72 (1.7) -
LV IVA, m/sec2 Pre-T 3.58 (0.39) 2.69 (0.37) - 3.8 (0.47) 2.6 (0.2) 0.046
End-T 3.37 (0.4) 2.67 (0.47) - 3.8 (0.47) 2.5 (0.36) 0.05
LV Tei index Pre-T 0.64 (0.06) 0.8 (0.15) - 0.62 (0.09) 0.72(0.1) -
End-T 0.71 (0.11) 0.75 (0.2) - 0.73 (0.17) 0.7 (0.1) -

Baseline characteristics of participants according to spontaneous breathing trial outcome.

Weaning success (N=14) Weaning failure P-value
EWF (<2h) (N=5) LWF (2-48h) (N=6)
Age, years 58.31 (4.47) 63.25 (2.95) 67.83 (6.84) 0.45
Gender (male) 11 (78.5) 3 (60) 4 (66.7) 0.69
Medical /Surgical critical state 3 (21.5) / 11 (78.5) 2 (40) / 3 (60) 4 (66.7) /2 (33.3) 0.08
  Sepsis 3 2 1
  Intoxication 0 0 1
  Pyelonephritis 0 0 1
  Status epilepticus 0 0 1
  Peritonitis 0 0 1
  Pancreatitis 1 0 0
  Neurosurgical 5 2 1
  Multiple trauma 2 0 0
  Cancer 1 1 0
  Hemorrhage 2 0 0
Arterial Hypertension 9 (64.3) 5 (100) 5 (83.3) 0.24
COPD 1 (7) 1 (20) 0 0.46
Diabetes mellitus 3 (21) 1 (20) 0 0.47
APACHE II (on admission) 14.9 (2.66) 18 (4.37) 8.33 (5.84) 0.36
SOFA (on admission) 8.54 (1.64) 7.25 (1.65) 9 (1.46) 0.86
Fluid balance, mL/day 2676 (630) 472 (1667) 2513 (1564) 0.35
Renal dysfunction 3 (21) 2 (40) 2 (33.3) 0.69
T-piece trial
ICU day of SBT 22.79 (6.06) 16 (6) 17.33 (2.65) 0.72
Orotracheal/Tracheostomy tube 11(78) / 3(21) 3(60) / 2(40) 4 (67) / 2(33) 0.69
SOFA 5.3 (0.9) 3.2 (1.1) 3.8 (0.7) 0.38
PaO2/FIO2 ratio 370 (31) 281 (78) 392 (36) 0.16
PEEP, cmH2O 6.3 (0.3) 7 (0.4) 6.7 (0.4) 0.52
f, breaths/min 19.7 (1.8) 24.2 (1.4) 21.1 (1.3) 0.24
VT, L 0.47 (0.014) 0.46 (0.017) 0.51 (0.026) 0.29
f /VT (RSBI) 41.7 (3.9) 52.9 (4.7) 42.3 (3.7) 0.20
PFP, cmH2O*breaths/min 264 (201) 316 (27) 280 (27) 0.52
MIP, cmH2O 23.6 (1.57) 23.2 (1.83) 25.71 (1.83) 0.63
BNP, pg/mL 412 (157) 761 (728) 455 (125) 0.70
Albumin, mg/dL 2.7 (0.1) 3 (0.2) 2.8 (0.1) 0.32

PiCCO hemodynamics according to spontaneous breathing trial outcome before (Pre-T) and following (End-T) the trial.

Weaning success (N=14) Weaning failure (N=11) P-value
MAP, mmHg Pre-T 86.5 (2.6) 95.2 (2.6) 0.02
End-T 91.1 (3.2) 100.4 (6.6) NS
HR, beats/min Pre-T 92.1 (4.8) 82.82 (5.2) NS
End-T 95.9 (4.4) 94.0 (57.6)* NS
RPP, beats*min−1*mmHg Pre-T 7974 (502) 7985 (603) NS
End-T 8786 (550) 9648 (1072) NS
ScvO2, % Pre-T 76.6 (1.7) 74.5 (3) NS
End-T 79 (1.5) 72.6 (2.5) 0.03
O2ER, % Pre-T 22.8 (1.6) 24.4 (2.9) NS
End-T 19.3 (1.5)* 24.3 (2.2) NS
CVP, mmHg Pre-T 5.43 (1) 11.27 (1.9) 0.01
End-T 4.86 (0.9) 10.82 (1.6) 0.01
EVLW, mL Pre-T 430 (20.4) 603 (56) 0.01
End-T 440 (30) 566.4 (43) 0.01
ELWI, mL/kg Pre-T 6.79 (0.7) 9 (0.7) 0.04
End-T 6.21 (0.6) 8.54 (0.7) 0.01
CI, L/min/m2 Pre-T 3.82 (0.3) 3.63 (0.3) NS
End-T 4.22 (0.3)* 4.25 (0.4)* NS
SVI, mL/m2 Pre-T 45.3 (3.4) 43.9 (4.8) NS
End-T 48.1 (3.3) 47 (4.3) NS
GEDI, mL/m2 Pre-T 659 (19) 846 (75) 0.013
End-T 691 (31) 861 (80) 0.04
PBV, mL Pre-T 349.3(12.4) 452 (82.6) NS
End-T 367.7(15.9) 410 (45.6) NS
SVRI, cm.d.sec−5m2 Pre-T 1833 (108) 2122 (199) NS
End-T 1755 (101) 1924 (222) NS
dPmx, mmHg/min Pre-T 1357 (118) 1070 (130) NS
End-T 1266 (154) 1146 (113) NS
PVP Pre-T 1.28 (0.1) 1.65 (0.2) 0.028
End-T 1.22 (0.1) 1.5 (0.2) NS
CFI, L/min Pre-T 5.79 (0.4) 4.58 (0.6) NS
End-T 6.16 (0.4) 5.25 (0.6) NS
GEF, % Pre-T 52.2 (3.8)* 42.36 (4)* NS
End-T 26.7 (0.9)* 23.94 (3)* NS

Univariate and independent determinants of extravascular lung water index (pre spontaneous breathing trial values)

Univariate linear regression analysis Multivariate linear regression analysis
r R2 P value b B (95%CI) P value
GEF −0.481 0.231 0.03 −0.013 −0.003 (−0.024 – 0.019) NS
LV Sm −0.487 0.237 0.01 0.004 0.004 (−0.131 – 0.139) NS
LV E/Em 0.404 0.163 0.04 0.203 0.133 (0.063 – 0.202) 0.01
CVP 0.431 0.185 0.03 −0.041 −0.018 (−0.066 – 0.031) NS
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