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Intensive Care Medicine

, 34:1231 | Cite as

Increase in plasma protein concentration for diagnosing weaning-induced pulmonary oedema

  • Nadia Anguel
  • Xavier MonnetEmail author
  • David Osman
  • Vincent Castelain
  • Christian Richard
  • Jean-Louis Teboul
Original

Abstract

Objective

Weaning-induced cardiogenic pulmonary oedema is a cause of weaning failure that is classically diagnosed by an increase in pulmonary artery occlusion pressure during a spontaneous breathing trial. During cardiogenic pulmonary oedema, a hypo-oncotic fluid is filtered toward the interstitial space. Thus, we tested whether the changes in plasma protein concentration during a weaning trial could diagnose weaning-induced pulmonary oedema.

Design

Prospective study.

Setting

The 24-bed medical intensive care unit of a university hospital.

Patients

Forty-six patients who had failed two weaning trials.

Intervention

Weaning-induced pulmonary oedema was diagnosed if a respiratory failure associated with an increase in pulmonary artery occlusion pressure above 18 mmHg occurred during a third weaning trial on a T-tube. The plasma protein concentration was measured before and at the end of the spontaneous breathing trial.

Measurements and results

During the weaning trial, pulmonary oedema was observed in 24 patients. In these patients, the plasma protein concentration increased by 11% (3–25%). The plasma protein concentration did not change significantly in patients who did not experience weaning-induced pulmonary oedema. An increase in the plasma protein concentration greater than 6% from baseline to the end of the weaning trial allowed detecting a weaning-induced pulmonary oedema with a sensitivity of 87% and a specificity of 95%.

Conclusion

The acute changes in plasma protein concentration during a weaning trial represent an alternative method to right heart catheterisation for assessing weaning-induced pulmonary oedema.

Keywords

Weaning from mechanical ventilation Pulmonary oedema Haemoconcentration 

Supplementary material

134_2008_1038_MOESM1_ESM.doc (43 kb)
Electronic Supplementary Material (DOC 43K)

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Nadia Anguel
    • 1
  • Xavier Monnet
    • 1
    • 2
    Email author
  • David Osman
    • 1
  • Vincent Castelain
    • 3
  • Christian Richard
    • 1
    • 2
  • Jean-Louis Teboul
    • 1
    • 2
  1. 1.Service de réanimation médicaleCentre Hospitalier Universitaire de Bicêtre, AP-HPLe Kremlin-BicêtreFrance
  2. 2.Faculté de médecine Paris-SudUniversité Paris-SudLe Kremlin-BicêtreFrance
  3. 3.Service de réanimation médicale, Hôpital de HautepierreHôpitaux Universitaires de StrasbourgStrasbourgFrance

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