Intensive Care Medicine

, Volume 31, Issue 12, pp 1643–1647 | Cite as

Fluid balance and weaning outcomes

  • Anupama Upadya
  • Lisa Tilluckdharry
  • Visvanathan Muralidharan
  • Yaw Amoateng-Adjepong
  • Constantine A. Manthous
Original

Abstract

Objective

To examine the relationship of fluid balance and weaning outcomes.

Methods

We prospectively collected demographic, physiological, daily fluid balance (measured inputs minus outputs), and weaning data from 87 mechanically ventilated patients.

Patients

We examined 87 patients, a median age of 66 years, APACHE II of 22, and performed 205 breathing trials (BT); 38 patients (44%) were successfully extubated after their first BT with minimal or no pressure support.

Results

Positive fluid balance (inputs>outputs) in the 24, 48, and 72 h and cumulatively (from hospital admission) prior to weaning were significantly greater in weaning failures than successes. Both univariate and multivariate analyses, adjusted for duration of mechanical ventilation and presence of chronic obstructive pulmonary disease, showed negative cumulative fluid balance 24 h prior to BTs (OR=2.9) and cumulative fluid balance (OR=3.4) to be independently associated with first-day weaning success. Similar relationships were demonstrated when all weaning attempts were analyzed. Negative fluid balance was as predictive of weaning outcomes as f/Vt (likelihood of success was 1.7 for patients with negative fluid balance 24 h prior to weaning and 1.2 for those with f/Vt<100 min−1 l−1). Although administration of diuretics was associated with more negative fluid balance, it was not independently associated with weaning outcomes.

Conclusions

These data suggest that fluid balance, a potentially modifiable factor, is associated with weaning outcomes. A randomized study is required to determine whether diuresis to treat positive fluid balance expedites liberation from mechanical ventilation.

Keywords

Weaning Extubation Mechanical ventilation Fluid Resuscitation 

References

  1. 1.
    Mutlu GM, Factor P (2000) Complications of mechanical ventilation. Respir Care Clin N Am 6:213–252CrossRefPubMedGoogle Scholar
  2. 2.
    Yang KL, Tobin MJ (1991) A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 324:1445–1450PubMedGoogle Scholar
  3. 3.
    MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, Fink JB, Heffner JE, Hess D, Hubmayer RD, Scheinhorn DJ (2001) Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 120:375S-95SCrossRefPubMedGoogle Scholar
  4. 4.
    Epstein SK (2000) Weaning parameters. Respir Care Clin N Am 6:253–301CrossRefPubMedGoogle Scholar
  5. 5.
    Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA (2001) Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 120:1262–1270CrossRefPubMedGoogle Scholar
  6. 6.
    Smina M, Salam A, Khamiees M, Gada P, Amoateng-Adjepong Y, Manthous CA (2003) Cough peak flows and extubation outcomes. Chest 124:262–268CrossRefPubMedGoogle Scholar
  7. 7.
    Smyrnios NA, Connolly A, Wilson MM, Curley FJ, French CT, Heard SO, Irwin RS (2002) Effects of a multifaceted, multidisciplinary, hospital-wide quality improvement program on weaning from mechanical ventilation. Crit Care Med 30:1224–1230CrossRefPubMedGoogle Scholar
  8. 8.
    Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–1477CrossRefPubMedGoogle Scholar
  9. 9.
    Franklin C, Samuel J, Hu TC (1994) Life-threatening hypotension associated with emergency intubation and the initiation of mechanical ventilation. Am J Emerg Med 12:425–428CrossRefPubMedGoogle Scholar
  10. 10.
    Luce JM (1984) The cardiovascular effects of mechanical ventilation and positive end-expiratory pressure. JAMA 252:807–811CrossRefPubMedGoogle Scholar
  11. 11.
    Alsous F, Khamiees M, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA (2000) Negative fluid balance predicts survival in patients with septic shock: a retrospective pilot study. Chest 117:1749–1754CrossRefPubMedGoogle Scholar
  12. 12.
    Upadya A, Ogbata S, Muralidharam V, Amoateng-Adjepong Y, Manthous CA (2003) Cumulative fluid balance affects weaning outcomes. Am J Respir Crit Care Med 167:A301Google Scholar
  13. 13.
    Hosmer DW, Lemeshow S (2000) Applied logistic regression. Wiley, New YorkGoogle Scholar
  14. 14.
    Lemaire F, Teboul JL, Cinotti L, Giotto G, Abrouk F, Steg G, Macquin-Mavier I, Zapol WM (1988) Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 69:171–179PubMedGoogle Scholar
  15. 15.
    Engoren M, Buderer NF, Zacharias A, Habib RH (1999) Variables predicting reintubation after cardiac surgical procedures. Ann Thorac Surg 67:661–665CrossRefPubMedGoogle Scholar
  16. 16.
    Epstein CD, Peerless JR, Mohamed HF, Wrenn ER, Kuestner ME (2003) Relationship between fluid balance & weaning in older critically ill surgical patients. Am J Crit Care 13:273Google Scholar
  17. 17.
    Khamiees M, Amoateng-Adjepong Y, Manthous CA (2002) Propofol infusion is associated with a higher rapid shallow breathing index in patients preparing to wean from mechanical ventilation. Respir Care 47:150–153PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Anupama Upadya
    • 1
  • Lisa Tilluckdharry
    • 1
  • Visvanathan Muralidharan
    • 1
  • Yaw Amoateng-Adjepong
    • 1
  • Constantine A. Manthous
    • 1
  1. 1.Pulmonary and Critical CareBridgeport Hospital and Yale University School of MedicineBridgeportUSA

Personalised recommendations