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Abstract
BackgroundDiaphragm dysfunction and weaning-induced pulmonary oedema are commonly involved during weaning failure, but their physiological interactions have been poorly reported. Our hypothesis was that diaphragm dysfunction is not particularly associated with weaning-induced pulmonary oedema.MethodsIt was a single-centre and physiological study conducted in patients who had failed a first spontaneous breathing trial and who underwent a second trial. The diaphragm function was evaluated by measuring the tracheal pressure generated in response to a bilateral magnetic phrenic nerves stimulations. Weaning-induced pulmonary oedema was diagnosed in case of failure of the spontaneous breathing trial if patients exhibited signs of plasma concentration or echocardiographic diagnosis of pulmonary artery occlusion pressure elevation.ResultsFifty-three patients were included and 31/53 (58%) failed the spontaneous breathing trial, including 24/31 (77%) patients with weaning-induced pulmonary oedema. Diaphragm dysfunction was present in 33/53 (62%) patients. Diaphragm dysfunction or weaning-induced pulmonary oedema were present in 26/31 (84%) of the patients who failed the spontaneous breathing trial. Weaning-induced pulmonary oedema occurred in 20/33 (61%) patients with a diaphragm dysfunction and in 4/20 (20%) patients without (p = 0.005).ConclusionWeaning-induced pulmonary oedema was three times more frequent in case of diaphragm dysfunction. Even in case of diaphragm dysfunction, physicians might be encouraged to investigate the presence of weaning-induced pulmonary oedema during weaning failure.
Highlights
This study shows that, in patients with difficult weaning: (1) diaphragm dysfunction and weaning-induced pulmonary oedema were frequent, both individually and combined and (2) lung ultrasound loss was associated with diaphragm dysfunction and spontaneous breathing trial failure
The definition of weaning-induced pulmonary oedema used in this study could explain the high prevalence, as we opted to standardize classification of patients based on objective criteria rather than classify patients based on expert consensus [1, 2], which may be subject to bias
Our findings show that patients with diaphragm dysfunction had a significantly higher lung ultrasound score (21 vs. 6), suggesting a greater lung aeration loss compared to patients without diaphragm dysfunction
Summary
Weaning-induced pulmonary oedema is a frequent cause of spontaneous breathing trial failure, accounting for up to 60% of weaning failure in two large observational studies [1, 2]. The respiratory distress that occurs during a failed spontaneous breathing trial involves large negative swings in pleural pressure that influence cardiac performance by increasing the venous return and/or increasing left ventricular afterload [12]. It may result in turn in weaning-induced pulmonary oedema [13, 14]. We hypothesized that diaphragm dysfunction would be more likely associated with lung aeration loss than with weaning-induced pulmonary oedema. Our hypothesis was that diaphragm dysfunction is not associated with weaning-induced pulmonary oedema
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