Fluid balance and weaning outcomes

Upadya, Anupama; Tilluckdharry, Lisa; Muralidharan, Visvanathan; Amoateng-Adjepong, Yaw; Manthous, Constantine A.

doi:10.1007/s00134-005-2801-3

Cited by 152 publications

(114 citation statements)

References 15 publications

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“…Previous observational studies [8][9][10] on weaning procedures found a correlation between higher fluid balance and extubation failure. However, there was considerable diversity in terms of populations evaluated, weaning and extubation protocols, and outcomes analyzed.…”

Section: See the Related Editorial On Page 1213mentioning

confidence: 99%

48-Hour Fluid Balance Does Not Predict a Successful Spontaneous Breathing Trial

et al. 2015

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BACKGROUND: Both premature and delayed liberation from mechanical ventilation are associated with increased morbidity and mortality, and fluid balance could negatively influence extubation outcomes. We sought to determine the impact of fluid balance in the 48 h before a spontaneous breathing trial (SBT) on weaning outcomes in a mixed ICU population. METHODS: This was a prospective observational study in 2 adult medical-surgical ICUs. All enrolled subjects met eligibility criteria for weaning from mechanical ventilation. SBT failure was defined as inability to tolerate a T-piece trial for 30 -120 min. Data on demographics, physiology, fluid balance in the 48 h preceding SBT (fluid input minus output over the 48-h period), lung ultrasound findings, and outcomes were collected. RESULTS: Of a total of 250 SBTs, SBT failure eventuated in 51 (20.4%). Twenty-nine subjects (11.6%) had COPD, and 40 subjects (16%) were intubated due to respiratory sepsis. One-hundred eighty-nine subjects (75.6%) were extubated on the first attempt. Compared with subjects with SBT success, SBT failure subjects were younger (median of 66 vs 75 y, P ‫؍‬ .001) and had a higher duration of mechanical ventilation (median of 7 vs 4 d, P < .001) and a higher prevalence of COPD (19.6 vs 9.5%, P ‫؍‬ .04). There were no statistically significant differences in

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Section: See the Related Editorial On Page 1213mentioning

confidence: 99%

48-Hour Fluid Balance Does Not Predict a Successful Spontaneous Breathing Trial

et al. 2015

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“…The SBT is presently the major diagnostic tool to determine if patients can be successfully extubated [1], and recent recommendations have been made to further increase the likelihood of successful extubation [8][9][10][11][12][13][14][15]. Nonetheless, extubation failure-defined as the need for ventilatory support or death within 48 h following extubation (adapted from [1])-is still prevalent, with reported reintubation rates of up to 19% [1,16,17] and 5-24% for rescue therapy with non-invasive ventilation (NIV) [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…The recommended approaches to evaluate the likelihood of successful extubation rely on objective criteria assessed by the clinician [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Little emphasis has been placed so far on the patients' subjective evaluation of the potential to sustain autonomous breathing, which might be influenced by psychological factors as well as the perceived work of breathing.…”

Section: Introductionmentioning

confidence: 99%

Patients’ prediction of extubation success

et al. 2010

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Purpose: The spontaneous breathing trial (SBT)-relying on objective criteria assessed by the clinician-is the major diagnostic tool to determine if patients can be successfully extubated. However, little is known regarding the patient's subjective perception of autonomous breathing. Methods: We performed a prospective observational study in 211 mechanically ventilated adult patients successfully completing a SBT. Patients were randomly assigned to be interviewed during this trial regarding their prediction of extubation success. We compared post-extubation outcomes in three patient groups: patients confident (confidents; n = 115) or not (nonconfidents; n = 38) of their extubation success and patients not subjected to interview (control group; n = 58). Results: Extubation success was more frequent in confidents than in non-confidents (90 vs. 45%; p \ 0.001/positive likelihood ratio = 2.00) or in the control group (90 vs. 78%; p = 0.04). On the contrary, extubation failure was more common in non-confidents than in confidents (55 vs. 10%; p \ 0.001/ negative likelihood ratio = 0.19). Logistic regression analysis showed that extubation success was associated with patient's prediction [OR (95% CI): 9.2 (3.74-22.42) for confidents vs.non-confidents] as well as to age [0.72 (0.66-0.78) for age 75 vs. 65 and 1.31 (1.28-1.51) for age 55 vs. 65]. Conclusions: Our data suggest that at the end of a sustained SBT, extubation success might be correlated to the patients' subjective perception of autonomous breathing. The results of this study should be confirmed by a large multicenter trial.

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“…In the last 10 years, a few interesting studies have been published on weaning and fluid balance. In one observational study, Upadya et al 6 found a correlation between negative fluid balance in the 24 h before an SBT and extubation success, suggesting that approaching weaning with a positive balance might be detrimental. Similarly, in a large multicenter observational study, Frutos-Vivar et al 7 reported that one of the risk factors for re-intubation was a positive fluid balance in the 24 h before extubation.…”

Section: See the Original Study On Pages 1091 1097mentioning

confidence: 99%