key: cord-0048473-ld07a53r
authors: Goudelin, Marine; Evrard, Bruno; Vignon, Philippe
title: Left ventricular overloading is the leading mechanism in extubation failure of patients at high-risk of weaning-induced pulmonary edema
date: 2020-08-06
journal: Intensive Care Med
DOI: 10.1007/s00134-020-06201-4
sha: 97d7b12e416fcb6672fa85a5a556f7f6380ad1f2
doc_id: 48473
cord_uid: ld07a53r

nan

We read with interest the correspondence by Sanfilippo et al. [1] who suggest performing further analysis for our recently reported study [2] . As per their thoughtful suggestion, we first redefined the two study groups as "weaning success" (n = 43) when the patient could be extubated without reinstitution of ventilator support within 48 h after extubation, and as "weaning failure" (n = 16) whenever one the following occurred: (i) failed spontaneous breathing trial (SBT) (n = 12); (ii) reintubation and/or resumption of ventilator support within 48 h after extubation (n = 3); or (iii) death in the 48 h after extubation (n = 1) [3] . When compared to patients who succeeded weaning, patients who failed had greater tachycardia and exhibited a higher E wave maximal velocity ( (Table 1) . These data confirm those reported initially when dichotomizing patients according to passed or failed SBT [2] .

Second, we investigated if the grade of LV diastolic dysfunction was associated with weaning failure [4] . Not surprisingly, the proportion of higher grades of LV diastolic dysfunction was significantly higher in patients who failed weaning, both at baseline and during SBT (Table 1) . At baseline, grade 1 was more frequent in the "weaning success" group, whereas grades 2 and 3 were more prevalent in the "weaning failure" group ( , respectively: p = 0.007). This highlights the facilitating role of underlying diastolic dysfunction in precipitating LV overload at the origin of weaning-induced pulmonary edema [5] .

Third, we performed a subgroup analysis in patients with chronic obstructive pulmonary disease (n = 15). In this subset of patients, those who failed weaning (n = 4) tended to have a higher E wave maximal velocity Overall, these additional analyses confirm the leading role of LV overload in the weaning failure of patients at high risk of developing a weaning-induced pulmonary *Correspondence: philippe.vignon@unilim.fr edema. Whether a therapeutic strategy based on such hemodynamic assessment could facilitate weaning in this targeted population remains to be determined.

HR heart rate, sBP systolic blood pressure, dBP diastolic blood pressure, mBP mean blood pressure, DTE deceleration time of mitral E wave, MR mitral regurgitation, LA left atrium, LVEF left ventricular ejection fraction, LVOT left ventricular outflow tract, VTI velocity-time integral, TR tricuspid regurgitation * According to [4] Weaning success (n = 43) Weaning failure (n = 16) P value 

Successful spontaneous breathing trial, early reintubation and mechanisms of weaning failure

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

Epidemiology of weaning outcome according to a new definition. The WIND study

Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the american society of echocardiography and the european association of cardiovascular imaging

Cardiovascular failure and weaning

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