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Intensive Care Medicine

, Volume 41, Issue 3, pp 487–494 | Cite as

Passive leg raising performed before a spontaneous breathing trial predicts weaning-induced cardiac dysfunction

  • Martin DresEmail author
  • Jean-Louis Teboul
  • Nadia Anguel
  • Laurent Guerin
  • Christian Richard
  • Xavier Monnet
Original

Abstract

Purpose

Weaning-induced cardiac dysfunction is more likely to occur if the heart does not tolerate the changes in loading conditions induced by spontaneous breathing trial (SBT). We hypothesized that the presence of cardiac preload independence before an SBT is associated with weaning failure related to cardiac dysfunction.

Methods

We included 30 patients after a first failed 1-h T-tube SBT who had a transpulmonary thermodilution already in place. Preload independence [no increase in the pulse contour analysis-derived cardiac index ≥10 % during passive leg raising (PLR)] was assessed before the second SBT. Failure of the SBT related to cardiac dysfunction was defined by an increase in pulmonary artery occlusion pressure above 18 mmHg at the end of the SBT associated with clinical intolerance.

Results

Fifty-seven SBTs were analyzed. The SBT failed in 46 cases. Overall, 31 failed SBTs were associated with weaning-induced cardiac dysfunction. During PLR, the cardiac index did not change in cases of failed SBTs with cardiac dysfunction, whereas it significantly increased in the other cases: 4 % (interquartile range, IQR 0–5) vs. 12 % (IQR 11–15), respectively. If PLR did not increase the cardiac index by more than 10 % before the SBT, the occurrence of SBT failure related to cardiac dysfunction was predicted with a sensitivity of 97 % [95 % confidence interval (CI) 83–100], specificity of 81 % (95 % CI 61–93) and area under the receiver-operating characteristic curve of 0.88 (95 % CI 0.78–0.98).

Conclusions

Preload independence assessed by a negative PLR test performed before an SBT predicts weaning failure related to cardiac dysfunction.

Keywords

Mechanical ventilation Weaning Pulmonary edema Passive leg raising 

Notes

Conflicts of interest

Jean-Louis Teboul and Xavier Monnet are members of the Medical Advisory Board of Pulsion Medical Systems. Martin Dres received honoraria for lectures from Pulsion Medical Systems. The other authors have no financial interest to disclose.

Supplementary material

134_2015_3653_MOESM1_ESM.pdf (28 kb)
Supplementary material 1 (PDF 28 kb)
134_2015_3653_MOESM2_ESM.pdf (40 kb)
Supplementary material 2 (PDF 39 kb)
134_2015_3653_MOESM3_ESM.doc (49 kb)
Supplementary material 3 (DOC 49 kb)
134_2015_3653_MOESM4_ESM.doc (41 kb)
Supplementary material 4 (DOC 41 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Martin Dres
    • 1
    • 2
    Email author
  • Jean-Louis Teboul
    • 1
    • 2
  • Nadia Anguel
    • 2
  • Laurent Guerin
    • 1
    • 2
  • Christian Richard
    • 1
    • 2
  • Xavier Monnet
    • 1
    • 2
  1. 1.EA4533Université Paris-SudLe Kremlin-BicêtreFrance
  2. 2.Service de réanimation médicaleHôpital de Bicêtre, Hôpitaux universitaires Paris-Sud, Assistance Publique, Hôpitaux de ParisLe Kremlin-BicêtreFrance

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