Early rise in central venous pressure during a spontaneous breathing trial: A promising test to identify patients at high risk of weaning failure?

English version

Autoři: Sebastián Dubo ^aff001; Emilio Daniel Valenzuela ^aff003; Andrés Aquevedo ^aff004; Manuel Jibaja ^aff005; Dolores Berrutti ^aff007; Christian Labra ^aff003; Rossana Lagos ^aff003; María Fernanda García ^aff005; Vanessa Ramírez ^aff005; Milton Tobar ^aff005; Fabricio Picoita ^aff005; Cristian Peláez ^aff005; David Carpio ^aff003; Leyla Alegría ^aff003; Carolina Hidalgo ^aff009; Karen Godoy ^aff010; Alejandro Bruhn ^aff003; Glenn Hernández ^aff003; Jan Bakker ^aff003; Ricardo Castro ^aff003
Působiště autorů: Departamento de Kinesiología, Facultad de Medicina, Universidad de Concepción, Concepción, Chile ^aff001; Programa de Doctorado en Ciencias Médicas, Universidad de la Frontera, Temuco, Chile ^aff002; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile ^aff003; Unidad de Pacientes Críticos, Hospital Dr. Sótero del Río, Santiago, Chile ^aff004; Unidad de Cuidados Intensivos, Hospital Eugenio Espejo, Quito, Ecuador ^aff005; Escuela de Medicina, Universidad Internacional de Ecuador, Quito, Ecuador ^aff006; Centro de Terapia Intensiva, Hospital de Clínicas, Universidad de la Republica de Uruguay, Montevideo, Uruguay ^aff007; Programa de Doctorado en Ciencias Médicas, Pontificia Universidad Católica de Chile, Santiago, Chile ^aff008; Unidad de Cuidados Intensivos Cardioquirúrgicos, Hospital Guillermo Grant Benavente, Concepción, Chile ^aff009; Unidad de Cuidados Intensivos Neuroquirúrgicos, Hospital Guillermo Grant Benavente, Concepción, Chile ^aff010; Department of Pulmonary and Critical Care, Columbia University College of Physicians and Surgeons, New York, New York, United States of America ^aff011; Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, Netherlands ^aff012; Department of Pulmonary and Critical Care, New York University Medical Center, New York, New York, United States of America ^aff013
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0225181

Souhrn

Background

The spontaneous breathing trial (SBT) assesses the risk of weaning failure by evaluating some physiological responses to the massive venous return increase imposed by discontinuing positive pressure ventilation. This trial can be very demanding for some critically ill patients, inducing excessive physical and cardiovascular stress, including muscle fatigue, heart ischemia and eventually cardiac dysfunction. Extubation failure with emergency reintubation is a serious adverse consequence of a failed weaning process. Some data suggest that as many as 50% of patients that fail weaning do so because of cardiac dysfunction. Unfortunately, monitoring cardiovascular function at the time of the SBT is complex. The aim of our study was to explore if central venous pressure (CVP) changes were related to weaning failure after starting an SBT. We hypothesized that an early rise on CVP could signal a cardiac failure when handling a massive increase on venous return following a discontinuation of positive pressure ventilation. This CVP rise could identify a subset of patients at high risk for extubation failure.

Methods

Two-hundred and four mechanically ventilated patients in whom an SBT was decided were subjected to a monitoring protocol that included blinded assessment of CVP at baseline, and at 2 minutes after starting the trial (CVP-test). Weaning failure was defined as reintubation within 48-hours following extubation. Comparisons between two parametric or non-parametric variables were performed with student T test or Mann Whitney U test, respectively. A logistic multivariate regression was performed to determine the predictive value on extubation failure of usual clinical variables and CVP at 2-min after starting the SBT.

Results

One-hundred and sixty-five patients were extubated after the SBT, 11 of whom were reintubated within 48h. Absolute CVP values at 2-minutes, and the change from baseline (dCVP) were significantly higher in patients with extubation failure as compared to those successfully weaned. dCVP was an early predictor for reintubation (OR: 1.70 [1.31,2.19], p<0.001).

Conclusions

An early rise in CVP after starting an SBT was associated with an increased risk of extubation failure. This might represent a warning signal not captured by usual SBT monitoring and could have relevant clinical implications.

Klíčová slova:

Respiratory physiology – Blood pressure – Catheters – Intensive care units – Cardiovascular physiology – Heart rate – Breathing

Zdroje

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