Diaphragm Dysfunction, Lung Aeration Loss and Weaning-induced Pulmonary Oedema in Difficult-to-wean Patients

Overview

Journal Ann Intensive Care

Specialty Critical Care

Date 2021 Jun 28

PMID 34181105

Citations 9

Authors

Martin Dres

Emmanuel Rozenberg

Elise Morawiec

Julien Mayaux

Julie Delemazure

Thomas Similowski

Alexandre Demoule

Affiliations

Soon will be listed here.

Abstract

Background: Diaphragm dysfunction and weaning-induced pulmonary oedema are commonly involved during weaning failure, but their physiological interactions have been poorly reported. Our hypothesis was that diaphragm dysfunction is not particularly associated with weaning-induced pulmonary oedema.

Methods: It was a single-centre and physiological study conducted in patients who had failed a first spontaneous breathing trial and who underwent a second trial. The diaphragm function was evaluated by measuring the tracheal pressure generated in response to a bilateral magnetic phrenic nerves stimulations. Weaning-induced pulmonary oedema was diagnosed in case of failure of the spontaneous breathing trial if patients exhibited signs of plasma concentration or echocardiographic diagnosis of pulmonary artery occlusion pressure elevation.

Results: Fifty-three patients were included and 31/53 (58%) failed the spontaneous breathing trial, including 24/31 (77%) patients with weaning-induced pulmonary oedema. Diaphragm dysfunction was present in 33/53 (62%) patients. Diaphragm dysfunction or weaning-induced pulmonary oedema were present in 26/31 (84%) of the patients who failed the spontaneous breathing trial. Weaning-induced pulmonary oedema occurred in 20/33 (61%) patients with a diaphragm dysfunction and in 4/20 (20%) patients without (p = 0.005).

Conclusion: Weaning-induced pulmonary oedema was three times more frequent in case of diaphragm dysfunction. Even in case of diaphragm dysfunction, physicians might be encouraged to investigate the presence of weaning-induced pulmonary oedema during weaning failure.

Citing Articles

Value of diaphragmatic ultrasound parameters in assessing weaning outcomes and survival in ventilator-dependent intensive care unit patients.

Pan L, Zhao J, Wang X, Huang L, Li S, Sun S Am J Transl Res. 2025; 16(12):7830-7839.

PMID: 39822550 PMC: 11733325. DOI: 10.62347/FDPE7053.

Lung aeration estimated by chest electrical impedance tomography and lung ultrasound during extubation.

Joussellin V, Bonny V, Spadaro S, Clerc S, Parfait M, Ferioli M Ann Intensive Care. 2023; 13(1):91.

PMID: 37752365 PMC: 10522557. DOI: 10.1186/s13613-023-01180-3.

Sonometric assessment of cough predicts extubation failure: SonoWean-a proof-of-concept study.

Bonny V, Joffre J, Gabarre P, Urbina T, Missri L, Ladoire M Crit Care. 2023; 27(1):368.

PMID: 37749612 PMC: 10521471. DOI: 10.1186/s13054-023-04653-w.

Use of thoracic ultrasound in acute respiratory distress syndrome.

Garcia-de-Acilu M, Santafe M, Roca O Ann Transl Med. 2023; 11(9):320.

PMID: 37404985 PMC: 10316096. DOI: 10.21037/atm-22-4576.

The increase in diaphragm thickness in preterm infants is related to birth weight: a pilot study.

Alonso-Ojembarrena A, Morales-Navarro A, Rodriguez-Medina J, Correro-Almagro A, Martinez-Garcia R, Lopez-de-Francisco R Eur J Pediatr. 2023; 182(8):3723-3732.

PMID: 37289234 DOI: 10.1007/s00431-023-05052-7.

References

Ferre A, Guillot M, Lichtenstein D, Meziere G, Richard C, Teboul J . Lung ultrasound allows the diagnosis of weaning-induced pulmonary oedema. Intensive Care Med. 2019; 45(5):601-608. DOI: 10.1007/s00134-019-05573-6. View

Teboul J . Weaning-induced cardiac dysfunction: where are we today?. Intensive Care Med. 2014; 40(8):1069-79. DOI: 10.1007/s00134-014-3334-4. View

Saccheri C, Morawiec E, Delemazure J, Mayaux J, Dube B, Similowski T . ICU-acquired weakness, diaphragm dysfunction and long-term outcomes of critically ill patients. Ann Intensive Care. 2020; 10(1):1. PMC: 6942110. DOI: 10.1186/s13613-019-0618-4. View

Soummer A, Perbet S, Brisson H, Arbelot C, Constantin J, Lu Q . Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress*. Crit Care Med. 2012; 40(7):2064-72. DOI: 10.1097/CCM.0b013e31824e68ae. View

Routsi C, Stanopoulos I, Kokkoris S, Sideris A, Zakynthinos S . Weaning failure of cardiovascular origin: how to suspect, detect and treat-a review of the literature. Ann Intensive Care. 2019; 9(1):6. PMC: 6326918. DOI: 10.1186/s13613-019-0481-3. View

Lemaire F, Teboul J, Cinotti L, Giotto G, Abrouk F, Steg G . Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology. 1988; 69(2):171-9. DOI: 10.1097/00000542-198808000-00004. View

Qing Q, Liang M, Sun Q, Xie B, Yang C, Liang W . Using twitch tracheal airway pressure, negative inhale forced pressure, and Medical Research Council score to guide weaning from mechanical ventilation. J Thorac Dis. 2018; 10(7):4424-4432. PMC: 6106045. DOI: 10.21037/jtd.2018.06.23. View

Reber A, Nylund U, Hedenstierna G . Position and shape of the diaphragm: implications for atelectasis formation. Anaesthesia. 1999; 53(11):1054-61. DOI: 10.1046/j.1365-2044.1998.00569.x. View

Dres M, Dube B, Goligher E, Vorona S, Demiri S, Morawiec E . Usefulness of Parasternal Intercostal Muscle Ultrasound during Weaning from Mechanical Ventilation. Anesthesiology. 2020; 132(5):1114-1125. DOI: 10.1097/ALN.0000000000003191. View

10.

Vivier E, Muller M, Putegnat J, Steyer J, Barrau S, Boissier F . Inability of Diaphragm Ultrasound to Predict Extubation Failure: A Multicenter Study. Chest. 2019; 155(6):1131-1139. DOI: 10.1016/j.chest.2019.03.004. View

11.

Anguel N, Monnet X, Osman D, Castelain V, Richard C, Teboul J . Increase in plasma protein concentration for diagnosing weaning-induced pulmonary oedema. Intensive Care Med. 2008; 34(7):1231-8. DOI: 10.1007/s00134-008-1038-3. View

12.

Froese A, Bryan A . Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology. 1974; 41(3):242-55. DOI: 10.1097/00000542-197409000-00006. View

13.

Buda A, Pinsky M, Ingels Jr N, Daughters 2nd G, Stinson E, Alderman E . Effect of intrathoracic pressure on left ventricular performance. N Engl J Med. 1979; 301(9):453-9. DOI: 10.1056/NEJM197908303010901. View

14.

Lamia B, Maizel J, Ochagavia A, Chemla D, Osman D, Richard C . Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation. Crit Care Med. 2009; 37(5):1696-701. DOI: 10.1097/CCM.0b013e31819f13d0. View

15.

Boles J, Bion J, Connors A, Herridge M, Marsh B, Melot C . Weaning from mechanical ventilation. Eur Respir J. 2007; 29(5):1033-56. DOI: 10.1183/09031936.00010206. View

16.

Bedet A, Tomberli F, Prat G, Bailly P, Kouatchet A, Mortaza S . Myocardial ischemia during ventilator weaning: a prospective multicenter cohort study. Crit Care. 2019; 23(1):321. PMC: 6751853. DOI: 10.1186/s13054-019-2601-8. View

17.

Jung B, Moury P, Mahul M, De Jong A, Galia F, Prades A . Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure. Intensive Care Med. 2015; 42(5):853-861. DOI: 10.1007/s00134-015-4125-2. View

18.

Dres M, Goligher E, Dube B, Morawiec E, Dangers L, Reuter D . Diaphragm function and weaning from mechanical ventilation: an ultrasound and phrenic nerve stimulation clinical study. Ann Intensive Care. 2018; 8(1):53. PMC: 5913054. DOI: 10.1186/s13613-018-0401-y. View

19.

Dres M, Roux D, Pham T, Beurton A, Ricard J, Fartoukh M . Prevalence and Impact on Weaning of Pleural Effusion at the Time of Liberation from Mechanical Ventilation: A Multicenter Prospective Observational Study. Anesthesiology. 2017; 126(6):1107-1115. DOI: 10.1097/ALN.0000000000001621. View

20.

Sklar M, Burns K, Rittayamai N, Lanys A, Rauseo M, Chen L . Effort to Breathe with Various Spontaneous Breathing Trial Techniques. A Physiologic Meta-analysis. Am J Respir Crit Care Med. 2016; 195(11):1477-1485. DOI: 10.1164/rccm.201607-1338OC. View