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Use of combined cardiac and lung ultrasound to predict weaning failure in elderly, high-risk cardiac patients: a pilot study

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A Correction to this article was published on 10 February 2020

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Abstract

Purpose

Weaning failure from mechanical ventilation may be due to lung de-recruitment or weaning-induced pulmonary oedema (WIPO). Both can be diagnosed by lung ultrasound (LUS) and transthoracic echocardiography (TTE), respectively. We conducted a prospective observational study, combining TTE and LUS, to determine if LUS alone may identify elderly patients at high risk of weaning or extubation failure.

Methods

Before and at the end of spontaneous breathing trials (SBT) in 40 elderly patients, we prospectively performed LUS and TTE. Extubation was decided by an independent operator. LUS included global and anterolateral LUS score. TTE included measurement of E/A and E/Ea ratios to determine LV filling pressures. SBT LUS scores for prediction of weaning outcome and for the diagnosis of WIPO were studied.

Results

Weaning or extubation failure was observed in 45% (95% CI 28–61) of patients. ROC analysis for ability of global SBT LUS to predict weaning/extubation failure and extubation failure found AUC of 0.80 and 0.81, respectively. AUC for anterolateral SBT LUS to predict weaning/extubation failure and extubation failure was 0.79 and 0.81, respectively. Increased LV filling pressure during SBT was observed without increase of anterolateral LUS score. Inversely, increase of anterolateral LUS was observed without increased filling pressure and was associated with extubation failure. Global and anterolateral SBT LUS were not correlated to E/Ea.

Conclusion

In elderly patients, global and anterolateral LUS scores were associated with weaning and extubation failures while echocardiographic indices of filling pressures were not.

Clinical trial number and registry URL

ClinicalTrials.gov No. NCT03261440.

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Change history

  • 10 February 2020

    The original version of this article unfortunately contained a mistake. Two of the authors forgot to mention recent collaborations in their COI. The correct COI would have been: Dr Silvia Mongodi received feed for lectures from General Electrics; and Professor Francesco Mojoli received feed for lectures from General Electrics, Hamilton Medical and SEDA SpA. The Authors apologise for the missing information.

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Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Care, C.H.U. Dijon, BP 77908, 21709, Dijon Cedex, France

    Belaid Bouhemad, Nicolas Nowobilski & Pierre- Grégoire Guinot

  2. Université Bourgogne Franche-Comté, LNC UMR866, 21000, Dijon, France

    Belaid Bouhemad

  3. Department of Anaesthesia and Intensive Care, Istituto Di Ricovero E Cura a Carattere Scientifico, Policlinico San Matteo Foundation, Pavia, Italy

    Francesco Mojoli & Silvia Mongodi

  4. Department of Anaesthesia and Intensive Care, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia

    Arif Hussain

  5. Department of Anaesthesia, CH Princesse Grace, Monte Carlo, Monaco

    Isabelle Rouquette

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  1. Belaid Bouhemad
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  2. Francesco Mojoli
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  3. Nicolas Nowobilski
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  4. Arif Hussain
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  6. Pierre- Grégoire Guinot
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  7. Silvia Mongodi
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Correspondence to Belaid Bouhemad.

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Bouhemad, B., Mojoli, F., Nowobilski, N. et al. Use of combined cardiac and lung ultrasound to predict weaning failure in elderly, high-risk cardiac patients: a pilot study. Intensive Care Med 46, 475–484 (2020). https://doi.org/10.1007/s00134-019-05902-9

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  • DOI: https://doi.org/10.1007/s00134-019-05902-9

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