Bagka Dimitra, Zakynthynos George, Tsolaki Vasiliki, Papanikolaou Jonh, Vazgiourakis Vasilis, Baka Maria, Pratsas Konstantinos, Makris Demosthenes
General University Hospital of Larissa, Larisa, Greece.
University of Athens, Athens, Greece.
J Crit Care Med (Targu Mures). 2024 Jan 30;10(1):64-72. doi: 10.2478/jccm-2024-0008. eCollection 2024 Jan.
To evaluate hemodynamic profiles of critical care patients undergoing spontaneous t-piece trial (SBT) and present weaning failure.
Prospective observational study conducted in ready-to-wean non-cardiac ICU patients. Clinical, echocardiographic and thermodilution-derived variables were recorded before and after a 2-hour SBT. Weaning from mechanical ventilation was defined as preservation of spontaneous breathing for 48 hours following successful SBT.
Fourteen patients succeeded weaning, five manifested T-trial-failure and six late-failure. Weaning outcome was significantly associated with ELWI(Extravascular lung-water index), global-end-diastolic index and impaired diastolic function, as indicated by pre-T Doppler early wave velocities (E/Em); Fifty-six percent of participants presented ELWI≥7mL/kg when fulfilling predetermined criteria for weaning. ELWI, impaired pulmonary permeability and left ventricular diastolic dysfunction were independent determinants of ELWI.
ELWI before SBT and impaired diastolic function (as indicated by pre-T E/Em) might be weaning outcome determinants and their assessment may allow better risk stratification in weaning decision making.
评估接受自主T管试验（SBT）的重症监护患者的血流动力学特征，并分析撤机失败情况。
对准备撤机的非心脏重症监护病房患者进行前瞻性观察研究。在2小时的SBT前后记录临床、超声心动图和热稀释衍生变量。机械通气撤机定义为SBT成功后自主呼吸维持48小时。
14例患者成功撤机，5例出现T管试验失败，6例出现延迟失败。撤机结果与血管外肺水指数（ELWI）、全心舒张末期指数和舒张功能受损显著相关，T管试验前多普勒早期波速度（E/Em）可表明舒张功能受损；56%的参与者在满足撤机预定标准时ELWI≥7mL/kg。ELWI、肺通透性受损和左心室舒张功能障碍是撤机失败的独立决定因素。
SBT前的ELWI和舒张功能受损（由T管试验前E/Em表示）可能是撤机结果的决定因素，对它们的评估可能有助于在撤机决策中进行更好的风险分层。
