1. M. Dres, J-L. Teboul, N. Anguel, L. Guerin, C. Richard, X. Monnet
Comparison between Extravascular lung water, B-type natriuretic peptide and blood volume contraction to detect weaning-induced pulmonary edema
M. Dres, J-L. Teboul, N. Anguel, L. Guerin, C. Richard, X. Monnet
Service de réanimation médicale, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre
EA4533, Université Paris-Sud, Le Kremlin-Bicêtre, France

2. Conflict of interest Prs Xavier Monnet and Jean-Louis Teboul:
members of the Medical Advisory Board of Pulsion Medical System

3. INDIRECT DIRECT Weaning of mechanical ventilation Background Methods
Results
Discussion
Weaning of mechanical ventilation
Weaning induced pulmonary edema : frequent and treatable
Teboul JL et al. Crit Care 2010
Clinical examination
Echocardiography
Biological : Blood volume contraction
B-type natriuretic peptide
Hemodynamic (right heart catheter)
INDIRECT
Measure of extravascular lung water
DIRECT

4. Transpulmonary Thermodilution
Background
Methods
Results
Discussion
Transpulmonary Thermodilution
Cold bolus
ΔTemp
time
EVLW
GEDV
PVPI…

5. Background
Methods
Results
Discussion
Hypothesis: 1
To detect weaning induced pulmonary edema by showing an increase in extravascular lung water 2
To confirm the ability of an increase in BNP and in plasma protein concentration and hemoglobin to diagnose weaning induced pulmonary edema

6. Baseline End of SBT Background Methods Results Discussion
During a SBT performed
24 hours after the failure of a first SBT
Patients with right heart catheter 1.
Patients ready to be weaned 2.
SBT on T-tube during 60 minutes 3.
Measurement of EVLW
BNP
Plasma protein concentration
hemoglobin
PAOP
Baseline
End of SBT
Weaning induced pulmonary edema : clinical intolerance + PAOP ≥18 mmHg

7. Background
Methods
Results
Discussion
36 SBTs
Primary analysis

8. Background Methods Results Discussion
Changes in EVLW during spontaneous breathing trial

9. Background Methods Results Discussion
Changes in plasma protein concentration during spontaneous breathing trial

10. Background Methods Results Discussion
Changes in hemoglobin during spontaneous breathing trial

11. Background Methods Results Discussion
Changes in B-type natriuretic peptide during spontaneous breathing trial

12. Background Methods Results Discussion
Diagnostic performance for the detection of weaning induced pulmonary edema
Weaning-induced changes in
plasma protein concentration
hemoglobin concentration
extravascular lung water
B-type natriuretic peptide 20 40 60 80
100 - S
pec i f c t y e n s v
100-
AUC 0.97
AUC 0.96 6%
AUC 0.89
14%
AUC 0.76

13. Background Methods Results Discussion Limits of the study
Performance of BNP : pro-BNP?
SBT on T-tube. Pressure support level?
Strengths of the study
Gold standard method to diagnose weaning induced pulmonary edema
Confirmation of the physiological approach by showing blood volume contraction

14. Conclusion Transpulmonary thermodilution enables to detect
increase in extravascular lung water
during weaning induced pulmonary edema
Blood volume contraction confirmed its relevance as an
Non invasive alternative tool in this context

15. Background
Methods
Results
Discussion
12%

16. Background Methods Results Discussion Weaning induced PE +