Abstract
RationalePostextubation distress after a successful spontaneous breathing trial (SBT) is associated with increased morbidity and mortality. Lung ultrasound determination of changes in lung aeration predicts weaning failure. It remains unknown whether this derecruitment is related to alveolar epithelial dysfunction or not.ObjectiveTo verify whether lung alveolar type I epithelial cell injury marker sRAGE (soluble form of the receptor for advanced glycation end-products) is predictive of postextubation distress and weaning failure or not, and to verify whether plasma sRAGE levels can be related to lung derecruitment during the process of weaning from mechanical ventilation or not.Interventions, Measurements88 patients from 2 intensive care units were included in this observational prospective study. Plasma sRAGE levels were measured in duplicate by ELISA before, at the end of a 60-minute SBT, and 4 hours after extubation. To quantify lung aeration, a lung ultrasound score was calculated.Main Results34% of extubated patients experienced postextubation distress. Patients with or without postextubation distress had comparable sRAGE levels before SBT, after SBT, and 4 hours after extubation. In patients with postextubation distress, sRAGE levels were not predictive of the need for mechanical ventilation. sRAGE levels were not associated with lung aeration as assessed by echography. Patients who succeeded SBT (86%) and those who failed (14%) had no differences in sRAGE levels, before (median 1111 vs 1021 pg/mL, p = 0,87) and at the end of SBT (1165 vs 1038 pg/mL, p = 0.74).ConclusionsPlasma levels of sRAGE do not predict postextubation distress or SBT failure/success in patients weaning from mechanical ventilation. Lung aeration loss during a successful weaning trial predicts postextubation distress, but may not be evaluable by plasma levels of sRAGE, a marker of alveolar type I epithelial cell injury.Trial RegistrationClinicalTrials.gov NCT01098773
Highlights
Weaning from mechanical ventilation is a critical period in intensive care unit (ICU) patients [1,2]
Plasma levels of sRAGE do not predict postextubation distress or spontaneous breathing trial (SBT) failure/success in patients weaning from mechanical ventilation
Patients Blood samples were available for sRAGE assessment in 88 out of 100 patients enrolled in a previously published study [5], and 88 patients were prospectively included in the present study between february and december 2010 (Figure 1)
Summary
Weaning from mechanical ventilation is a critical period in intensive care unit (ICU) patients [1,2]. Weaning failure includes initial spontaneous breathing trial (SBT) failure, postextubation distress and death occuring within 48 h following extubation [1]. Postextubation distress is defined as reintubation or need for noninvasive ventilation within 48 hours following extubation [1,3]. Postextubation distress after a successful SBT is associated with increased morbidity and mortality [4]. Given the risks associated with delayed or unsuccessful extubation, determining readiness for extubation and predicting postextubation distress is a critical challenge in the ICU. Most of proposed predictors of postextubation distress either require special equipment, or are too complex for bedside use, or have a limited predictive value [3]. There are no simple clinical indices known to be powerful predictors of postextubation distress.
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