Successful spontaneous breathing trial, early reintubation and mechanisms of weaning failure
- PDF / 562,681 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 37 Downloads / 167 Views
CORRESPONDENCE
Successful spontaneous breathing trial, early reintubation and mechanisms of weaning failure Filippo Sanfilippo1* , Paolo Murabito1,2, Valeria La Rosa3, Francesco Oliveri1 and Marinella Astuto1,2 © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Dear Editor, We read with great interest the elegant study recently published by the group of Goudelin et al. [1] where authors studied weaning from mechanical ventilation (MV) in a population with chronic-obstructive pulmonary disease (COPD) and/or heart failure with reduced ejection fraction (HFrEF). The authors confirmed that left ventricular (LV) overloading is a key aspect of weaning-induced pulmonary oedema (WiPO). As cardiovascular dysfunction accounts for the majority of weaning failures (WiPO quoted around 60% of failures by the largest published study) [2], the role of echocardiography is becoming prominent also in this context [3]. Weaning failure and prolonged MV are associated with longer intensive care unit stay, greater healthcare costs, increased morbidity and mortality [4]. The recent International Consensus Conference and WIND study [4] defined weaning failure as the occurrence of any of these: (a) failed spontaneous breathing trial (SBT); (b) reintubation/resumption of ventilator support within 48 h after extubation; or (c) death within 48 h after extubation. Therefore, the importance of extubation failure cannot be overemphasized and this seems rather logical as reintubation exposes patients to life-threatening complications. For these reasons, most studies on weaning from MV have included reintubation among the criteria for weaning failure (Table 1). In this interesting study published in the journal [1], the authors showed that 47 out of 59 patients successfully *Correspondence: [email protected] 1 Department of Anaesthesia and Intensive Care, A.O.U., “PoliclinicoVittorio Emanuele” University Hospital, Catania, Italy Full author information is available at the end of the article
passed their first SBT, while 12 had failed. Noteworthy, four patients “passing the SBT” subsequently met the criteria of “extubation failure within 48 h”, but they were still analysed as “successful SBT”. In light of the abovementioned international definition [4] and of the most common approach to define weaning failure, we ask the authors to provide data separating the study population in 43 patients (lasting successful SBT) vs 16 patients (12 SBT failure, 4 early reintubation). Besides this request, we would like to applaud the authors for collecting data on all the five recently recommended parameters for the evaluation of LV diastolic dysfunction (LVDD), a very challenging task in the intensive care setting [5]. It would be interesting to investigate if the overall grading of LVDD was associated with weaning failure, since three parameters (E wave, E/A ratio and tricuspid regurgitant jet velocity) were significantly different between groups, while the other two (e′ wave and E/e′ ratio) were not. Finally, the study population included a
Data Loading...
