M. Dres, J-L. Teboul, N. Anguel, L. Guerin, C. Richard, X. Monnet

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Presentation transcript:

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

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

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

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

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

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

Background Methods Results Discussion 36 SBTs Primary analysis

Background Methods Results Discussion Changes in EVLW during spontaneous breathing trial

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

Background Methods Results Discussion Changes in hemoglobin during spontaneous breathing trial

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

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

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

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

Background Methods Results Discussion 12%

Background Methods Results Discussion Weaning induced PE +