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Comparison between Extravascular lung water, B-type natriuretic peptide and blood volume contraction to detect weaning-induced pulmonary edema M. Dres,

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Presentation on theme: "Comparison between Extravascular lung water, B-type natriuretic peptide and blood volume contraction to detect weaning-induced pulmonary edema M. Dres,"— Presentation transcript:

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

3 Background Methods Results Discussion Weaning of mechanical ventilation frequenttreatable 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) Clinical examination Echocardiography Biological : Blood volume contraction B-type natriuretic peptide Hemodynamic (right heart catheter) INDIRECT DIRECT Measure of extravascular lung water

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

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

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

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 AUC 0.96 AUC % 14% AUC 0.97 AUC 0.89

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

14 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 Conclusion

15 Background Methods Results Discussion 12%

16 Background Methods Results Discussion Weaning induced PE + Weaning induced PE -


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