撤机诱发肺水肿的发病率及危险因素：一项多中心观察性研究的结果

Incidence and risk factors of weaning-induced pulmonary oedema: results from a multicentre, observational study.

作者信息

Shi Rui, Ayed Soufia, Beuzelin Marion, Persichini Romain, Legouge Marie, Vita Nello D E, Levy Bruno, Beurton Alexandra, Mangal Kishore, Hullin Thomas, Labbe Vincent, Guillot Max, Harrois Anatole, Cecconi Maurizio, Anguel Nadia, Osman David, Moretto Francesca, Lai Christopher, Pham Tài, Teboul Jean-Louis, Monnet Xavier

机构信息

Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, Université Paris-Saclay, Le Kremlin-Bicêtre, France.

FHU SEPSIS, Inserm UMR S_999, Groupe de Recherche Clinique CARMAS, Le Kremlin-Bicêtre, France.

出版信息

Crit Care. 2025 Mar 31;29(1):140. doi: 10.1186/s13054-025-05350-6.

DOI:10.1186/s13054-025-05350-6

PMID:40165223

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11956494/

Abstract

BACKGROUND

During the weaning process, the transition from positive to negative pressure ventilation may induce cardiac dysfunction, which may lead to pulmonary oedema. The incidence of weaning-induced pulmonary oedema (WIPO) is poorly documented and shows huge variations. Our study aims to investigate the incidence and risk factors for WIPO during weaning from mechanical ventilation in general critically ill patients.

METHODS

This multicentre study was conducted in France, Italy, and India. Adult critically ill patients receiving invasive ventilation were included once a spontaneous breathing trial (SBT) was performed. The SBT technique could be either T-piece or pressure support mode with (PSV-PEEP) or without positive end expiratory pressure (PEEP) (PSV-ZEEP). A consensual diagnosis of WIPO was made a posteriori by five experts who analysed changes observed during the SBT that were retrospectively recorded.

RESULTS

From July 2019 to February 2021, 634 SBTs were performed in 500 patients from 13 ICUs. Weaning success occurred in 417 patients (66%) and weaning failure in 217 (34%). Weaning was short in 414 (83%) of SBTs, difficult in 47 (9%) SBTs, and prolonged in 39 (8%) SBTs. WIPO was diagnosed in 79 (12%) cases, which accounted for 36% of the 217 weaning failures. WIPO occurred in 54/358 (15%) of T-piece SBT, in 7/84 (8%) of PSV-PEEP SBT (p = 0.072 vs. T-piece), and in 18/192 (9%) of PSV-ZEEP SBT (p = 0.002 vs. T-piece). In multilevel logistic regression analysis including 202 weaning failures from 149 different patients, COPD, and previous cardiomyopathy were identified as independent risk factors associated with WIPO.

CONCLUSION

In general ICU patients, WIPO accounts for 36% of weaning failure cases. Previous heart disease and COPD are two independent risk factors for developing WIPO during the weaning process.

CLINICALTRIALS

gov identifier (retrospectively registered on 2022-03-31): NCT05318261.

摘要

背景

在撤机过程中，从正压通气转换为负压通气可能会诱发心脏功能障碍，进而导致肺水肿。撤机诱发肺水肿（WIPO）的发生率记录较少，且差异很大。我们的研究旨在调查一般危重症患者机械通气撤机期间WIPO的发生率及危险因素。

方法

这项多中心研究在法国、意大利和印度进行。一旦进行了自主呼吸试验（SBT），纳入接受有创通气的成年危重症患者。SBT技术可以是T管法或压力支持模式，带呼气末正压（PSV-PEEP）或不带呼气末正压（PEEP）（PSV-ZEEP）。由五名专家对SBT期间观察到的变化进行回顾性记录，并做出WIPO的共识性事后诊断。

结果

2019年7月至2021年2月，来自13个重症监护病房的500例患者进行了634次SBT。417例患者（66%）撤机成功，217例（34%）撤机失败。414次（83%）SBT撤机时间短，47次（9%）SBT撤机困难，39次（8%）SBT撤机时间延长。79例（12%）诊断为WIPO，占217例撤机失败病例的36%。T管法SBT的54/358例（15%）发生WIPO，PSV-PEEP SBT的7/84例（8%）发生WIPO（与T管法相比，p = 0.072），PSV-ZEEP SBT的18/192例（9%）发生WIPO（与T管法相比，p = 0.002）。在包括来自149名不同患者的202例撤机失败病例的多水平逻辑回归分析中，慢性阻塞性肺疾病（COPD）和既往心肌病被确定为与WIPO相关的独立危险因素。