Left ventricular overloading is the leading mechanism in extubation failure of patients at high-risk of weaning-induced
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CORRESPONDENCE
Left ventricular overloading is the leading mechanism in extubation failure of patients at high‑risk of weaning‑induced pulmonary edema Marine Goudelin1,2, Bruno Evrard1,2 and Philippe Vignon1,2,3,4* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Dear Editor, 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 (103 cm/s [84–140] vs. 81 cm/s [61–89]: p = 0.002), an increased E/A ratio (1.4 [0.9–2.3] vs. 0.9 [0.7–1.1]: p = 0.002), a shorter E wave deceleration time (110 ms [97–158] vs. 173 ms [130–212]: p = 0.014) and a higher tricuspid regurgitation peak velocity (3.37 m/s [2.70– 3.87] vs. 2.83 m/s [2.57–3]: p = 0.034), while baseline left ventricular (LV) ejection fraction and LV outflow tract velocity–time integral were lower (29% [18–36] vs. 35% [26–40]: p = 0.056; and 14.5 [8.5–19.1] vs. 16.7 [13.5– 21.1]: p = 0.034, respectively). In contrast, no significant difference in the E′ wave maximal velocity and E/E′ ratio was noted (Table 1). During SBT, variations of Doppler *Correspondence: [email protected] 4 Réanimation Polyvalente, CHU Dupuytren, 2 Avenue Martin Luther king, 87042 Limoges, France Full author information is available at the end of the article
parameters were more marked in patients who failed than in those who succeeded weaning: higher increase of E wave maximal velocity (122 cm/s [92–160] vs. 93 cm/s [73–105]: p = 0.002) and of E/A ratio (1.7 [1–3.5] vs. 0.9 [0.7–1.3]: p = 0.001), and greater shortening of E wave deceleration time (88 ms [74–141] vs. 147 ms [105–174]: p = 0.024). Again, no significant difference was observed for the E′ wave maximal velocity and E/E′ ratio (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 (25/43 [58%] vs. 3/16 [19%] and 13/16 [81%] vs. 18/43 [42%], respectively: p = 0.007). This highlights the facilitating role
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