Résumé
Au cours du processus de sevrage de la ventilation mécanique, de nombreux mécanismes peuvent être à l’origine de l’échec d’une épreuve de ventilation spontanée (EVS). L’identification précise, le plus souvent respiratoire, cardiovasculaire ou neuromusculaire de la cause de l’échec d’une EVS est indispensable, car elle permet une prise en charge thérapeutique adaptée. L’observation clinique, le monitoring cardiovasculaire ou plus simplement l’échocardiographie transthoracique, les modifications induites par la réalisation d’une EVS de variables biologiques comme la protidémie, l’hémoglobine ou le peptide natriurétique de type B (BNP) et l’enregistrement électromyographique au lit du patient permettent cette indispensable analyse physiopathologique, base de la prise en charge thérapeutique.
Abstract
During mechanical ventilation weaning process, several mechanisms could lead to the failure of spontaneous breathing trial. Early identification of the reasons, mostly respiratory, cardiovascular or neuromuscular, is essential since it may result in a specific therapeutic management. Clinical examination, cardiovascular monitoring, transthoracic echocardiography, changes induced by spontaneous breathing trial in biological variables like plasma protein concentration, haemoglobin or B-type natriuretic peptide, and bedside electromyographic recording allow this crucial physiopathological analysis, which represents the basis of therapeutic care.
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Références
Klompas M (2013) Complications of mechanical ventilation — the CDC’s new surveillance paradigm. N Engl J Med 368:1472–1475
Kollef MH (2013) Ventilator-associated complications, including infection-related complications: the way forward. Crit Care Clin 29:33–50
Richard C, Beydon L, Cantagrel S, et al (2001) Conférence de consensus commune sevrage de la ventilation mecanique (à l’exclusion du nouveau-né et du réveil d’anesthésie). Réanimation 10: 699–705
Brochard L (2005) Pressure support is the preferred weaning method. As presented at the 5th International Consensus Conference in Intensive Care Medicine: Weaning from Mechanical Ventilation. Hosted by ERS, ATS, ESICM, SCCM and SRLF, Budapest
Boles JM, Bion J, Connors A, et al (2007) Weaning from mechanical ventilation. Eur Respir J 29:1033–1056
MacIntyre N (2007) Discontinuing mechanical ventilatory support. Chest 132:1049–1056
Perren A, Brochard L (2013) Managing the apparent and hidden difficulties of weaning from mechanical ventilation. Intensive Care Med 39:1885–1895
Leung P, Jubran A, Tobin MJ (1997) Comparison of assisted ventilator modes on triggering, patient effort, and dyspnea. Am J Respir Crit Care Med 155:1940–1948
Tobin MJ, Laghi F, Jubran A (2010) Narrative review: ventilatorinduced respiratory muscle weakness. Ann Intern Med 153:240–245
Teboul JL, Monnet X, Richard C (2010) Weaning failure of cardiac origin: recent advances. Crit Care 14:211
Chatila W, Ani S, Guaglianone D, et al (1996) Cardiac ischemia during weaning from mechanical ventilation. Chest 109:1577–1583
Lemaire F, Teboul JL, Cinotti L, et al (1988) Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 69:171–179
Janicki JS, Weber KT (1980) The pericardium and ventricular interaction, distensibility, and function. Am J Physiol 238:H494–H503
Frutos-Vivar F, Ferguson ND, Esteban A, et al (2006) Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 130:1664–1671
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 342:1471–1477
Garnacho-Montero J, Amaya-Villar R, García-Garmendía JL, et al (2005) Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med 33:349–354
De Jonghe B, Bastuji-Garin S, Sharshar T, et al (2004) Does ICU-acquired paresis lengthen weaning from mechanical ventilation? Intensive Care Med 30:1117–1121
Demoule A, Jung B, Prodanovic H, et al (2013) Diaphragm dysfunction on admission to ICU. Prevalence, risk factors and prognostic impact — a prospective study. Am J Respir Crit Care Med Am J Respir Crit Care Med 188:213–219
Doorduin J, van Hees HWH, van der Hoeven JG, Heunks LMA (2013) Monitoring of the respiratory muscles in the critically ill. Am J Respir Crit Care Med 187:20–27
Parrillo JE, Parker MM, Natanson C, et al (1990) Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med 113:227–242
Parker MM, Shelhamer JH, Bacharach SL, et al (1984) Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med 100:483–490
De Jonghe B, Bastuji-Garin S, Durand MC, et al (2007) Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Crit Care Med 35:2007–2015
Hermans G, Agten A, Testelmans D, et al (2010) Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study. Crit Care 14:R127
Dekhuijzen PN, Gayan-Ramirez G, Bisschop A, et al (1995) Corticosteroid treatment and nutritional deprivation cause a different pattern of atrophy in rat diaphragm. J Appl Physiol 78:629–637
Levine S, Nguyen T, Taylor N, et al (2008) Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 358:1327–1335
Jaber S, Petrof BJ, Jung B, et al (2011) Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. Am J Respir Crit Care Med 183:364–371
Diehl JL, Lofaso F, Deleuze P, et al (1994) Clinically relevant diaphragmatic dysfunction after cardiac operations. J Thorac Cardiovasc Surg 107:487–498
Matamis D, Soilemezi E, Tsagourias M, et al (2013) Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications. Intensive Care Med 39:801–810
Cassese M, Martinelli G, Nasso G, et al (2006) Topical cooling for myocardial protection: the results of a prospective randomized study of the “shallow technique.” J Card Surg 21:357–362
Dureuil B, Viirès N, Cantineau JP, et al (1986) Diaphragmatic contractility after upper abdominal surgery. J Appl Physiol 61: 1775–1780
Kim SH, Na S, Choi JS, et al (2010) An evaluation of diaphragmatic movement by M-mode sonography as a predictor of pulmonary dysfunction after upper abdominal surgery. Anesth Analg 110: 1349–1354
Simonneau G, Vivien A, Sartene R, et al (1983) Diaphragm dysfunction induced by upper abdominal surgery. Role of postoperative pain. Am Rev Respir Dis 128:899–903
Unoki T, Mizutani T, Toyooka H (2004) Changes in respiratory physiological dead space and compliance during non-abdominal, upper abdominal and lower abdominal surgery under general anaesthesia. Eur J Anaesthesiol 21:302–308
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 342:1471–1477
Kollef MH, Levy NT, Ahrens TS, et al (1998) The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest 114:541–548
Barr J, Kishman CP Jr, Jaeschke R (2013) The methodological approach used to develop the 2013 Pain, Agitation, and Delirium Clinical Practice Guidelines for adult ICU patients. Crit Care Med 41:S1–S15
De Jonghe B, Bastuji-Garin S, Fangio P, et al (2005) Sedation algorithm in critically ill patients without acute brain injury. Crit Care Med 33:120–127
Sauder P, Andreoletti M, Cambonie G, et al (2008) Sedation and analgesia in intensive care (with the exception of new-born babies). French Society of Anesthesia and Resuscitation. French-speaking Resuscitation Society. Ann Fr Anesth Reanim 27:541–551
Jubran A, Lawm G, Kelly J, et al (2010) Depressive disorders during weaning from prolonged mechanical ventilation. Intensive Care Med 36:828–835
Jubran A, Lawm G, Duffner LA, et al (2010) Post-traumatic stress disorder after weaning from prolonged mechanical ventilation. Intensive Care Med 36:2030–2037
Cammarano WB, Pittet JF, Weitz S, et al (1998) Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients. Crit Care Med 26:676–684
Sztrymf B, Chevrel G, Bertrand F, et al (2010) Beneficial effects of loxapine on agitation and breathing patterns during weaning from mechanical ventilation. Crit Care 14:R86
Liatsi D, Tsapas B, Pampori S, et al (2009) Respiratory, metabolic and hemodynamic effects of clonidine in ventilated patients presenting with withdrawal syndrome. Intensive Care Med 35:275–281
Zapata L, Vera P, Roglan A, et al (2011) B-type natriuretic peptides for prediction and diagnosis of weaning failure from cardiac origin. Intensive Care Med 37:477–485
Chien JY, Lin MS, Huang YCT, et al (2008) Changes in B-type natriuretic peptide improve weaning outcome predicted by spontaneous breathing trial. Crit Care Med 36:1421–1426
Mekontso-Dessap A, de Prost N, Girou E, et al (2006) B-type natriuretic peptide and weaning from mechanical ventilation. Intensive Care Med 32:1529–1536
Ait-Oufella H, Tharaux PL, Baudel JL, et al (2007) Variation in natriuretic peptides and mitral flow indexes during successful ventilatory weaning: a preliminary study. Intensive Care Med 33:1183–1186
Mekontso Dessap A, Roche-Campo F, Kouatchet A, et al (2012) Natriuretic peptide-driven fluid management during ventilator weaning: a randomized controlled trial. Am J Respir Crit Care Med 186:1256–1263
Anguel N, Monnet X, Osman D, et al (2008) Increase in plasma protein concentration for diagnosing weaning-induced pulmonary oedema. Intensive Care Med 34:1231–1238
Figueras J, Weil MH (1978) Blood volume prior to and following treatment of acute cardiogenic pulmonary edema. Circulation 57:349–355
Jubran A, Mathru M, Dries D, Tobin MJ (1998) Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof. Am J Respir Crit Care Med 158:1763–1769.
Monnet X (2008) Mesure de l’eau extravasculaire pulmonaire. Réanimation 17:66–73
Dres M, Teboul JL, Anguel N, et al (2013) Extra lung water for diagnosing weaning-induced pulmonary oedema. Crit Care 17(Suppl 2):95
Lamia B, Maizel J, Ochagavia A, et al (2009) Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation. Crit Care Med 37:1696–1701
Beaulieu Y (2007) Bedside echocardiography in the assessment of the critically ill. Crit Care Med 35:S235–S249
Charron C, Vignon P, Prat G, et al (2013) Number of supervised studies required to reach competence in advanced critical care transesophageal echocardiography. Intensive Care Med 39:1019–1024
Papanikolaou J, Makris D, Saranteas T, et al (2011) New insights into weaning from mechanical ventilation: left ventricular diastolic dysfunction is a key player. Intensive Care Med 37:1976–1985
Saleh M, Vieillard-Baron A (2012) On the role of left ventricular diastolic function in the critically ill patient. Intensive Care Med 38:189–191
De Backer D, El Haddad P, Preiser JC, Vincent JL (2000) Hemodynamic responses to successful weaning from mechanical ventilation after cardiovascular surgery. Intensive Care Med 26:1201–1206
Teboul JL, Abrouk F, Lemaire F (1988) Right ventricular function in COPD patients during weaning from mechanical ventilation. Intensive Care Med 14(Suppl 2):483–485
Combes A, Arnoult F, Trouillet JL (2004) Tissue doppler imaging estimation of pulmonary artery occlusion pressure in ICU patients. Intensive Care Med 30:75–81
Boussuges A, Blanc P, Molenat F, et al (2002) Evaluation of left ventricular filling pressure by transthoracic Doppler echocardiography in the intensive care unit. Crit Care Med 30:362–367
Paulus WJ, Tschöpe C, Sanderson JE, et al (2007) How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 28:2539–2550
Aurigemma GP, Gaasch WH (2004) Clinical practice. Diastolic heart failure. N Engl J Med 351:1097–1105
Nagueh SF, Appleton CP, Gillebert TC, et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 10:165–193
Summerhill EM, El-Sameed YA, Glidden TJ, McCool FD (2008) Monitoring recovery from diaphragm paralysis with ultrasound. Chest 133:737–743
Lerolle N, Guérot E, Dimassi S, et al (2009) Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery. Chest 135:401–407
Jiang JR, Tsai TH, Jerng JS, et al (2004) Ultrasonographic evaluation of liver/spleen movements and extubation outcome. Chest 126:179–185
Kim WY, Suh HJ, Hong SB, et al (2011) Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation. Crit Care Med 39:2627–2630
Soummer A, Perbet S, Brisson H, et al (2012) Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress*. Crit Care Med 40:2064–2072
Dres M, Schmidt M, Ferre A, et al (2012) Diaphragm electromyographic activity as a predictor of weaning failure. Intensive Care Med 38:2017–2025
Bellani G, Mauri T, Coppadoro A, et al (2013) Estimation of patient’s inspiratory effort from the electrical activity of the diaphragm. Crit Care Med Crit Care Med 41:1483–1491
Parthasarathy S, Jubran A, Laghi F, Tobin MJ (2007) Sternomastoid, rib cage, and expiratory muscle activity during weaning failure. J Appl Physiol 103:140–147
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Dres, M., Guerin, L. & Richard, C. Approche diagnostique de l’échec de l’épreuve de ventilation spontanée au cours du processus de sevrage de la ventilation mécanique. Réanimation 23, 37–47 (2014). https://doi.org/10.1007/s13546-013-0829-x
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DOI: https://doi.org/10.1007/s13546-013-0829-x