Thoracic fluid content: a novel parameter for predicting failed weaning from mechanical ventilation

Abstract

Background: Weaning of patients from the mechanical ventilation remains one of the critical decisions in intensive care unit. This study aimed to evaluate the accuracy of thoracic fluid content (TFC) as a predictor of weaning outcome.Methods: An observational cohort study included 64 critically ill surgical patients who were eligible for extubation. Before initiating the spontaneous breathing trial, the TFC was measured using the electrical cardiometry technology. Patients were followed up after extubation and divided into successful weaning group and failed weaning group. Both groups were compared according to respiratory and cardiovascular parameters. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of TFC to predict weaning outcome. Results: The number of successfully weaned patients was 41/64 (64%). Twenty (31%) patients had impaired cardiac contractility, and of them, 13/20 (64%) patients were successfully extubated. Both groups, successful weaning group and failed weaning group, were comparable in most of baseline characteristics; however, the TFC was significantly higher in the failed weaning group compared to the successful weaning group. The area under the ROC curves (AUCs) showed moderate predictive ability for the TFC in predicting weaning failure (AUC [95% confidence interval] 0.69 [0.57-0.8], cutoff value > 50 kΩ −1 ), while the predictive ability of TFC was excellent in the subgroup of patients with ejection fraction < 40% (AUC [95% confidence interval 0.93 [0.72-1], cutoff value > 50 kΩ −1 ). Conclusions: Thoracic fluid content showed moderate ability for predicting weaning outcome in surgical critically ill patients. However, in the subgroup of patients with ejection fraction less than 40%, TFC above 50 kΩ −1 has an excellent ability to predict weaning failure.

Clinical study of Dysfunctional Ventilatory Weaning Response in critically ill patients

“…Although, in this study no statistically significant differences were identified between the extubation failure and success groups according to the medical diagnosis at admission and to the comorbidities. Some authors ( 25 , 29 - 31 ) observed that sepsis, heart disease, obstructive pulmonary diseases and previous diseases such as cancer, hypertension and stroke were factors significantly associated with the occurrence of extubation failure, which may have not been identified in this research due to the small sample included or the clinical profile of the individuals studied.…”

Non-invasive Cardiac Output Monitoring and Assessment of Fluid Responsiveness in Children With Shock in the Emergency Department

“…In our study, we observed a significant decrease in RR, MAP, SVR, and STR and an increase in TFC, while CO, CI, SV, and SI remained unchanged. TFC is a newer objective parameter that has shown to identify pulmonary congestion which might not be evident on chest x-rays ( 36 , 37 ). One study in critically ill children with respiratory failure and shock demonstrated that high TFC values correlate with pulmonary plethora and predicted patient outcomes ( 37 ).…”

“…TFC is a newer objective parameter that has shown to identify pulmonary congestion which might not be evident on chest x-rays ( 36 , 37 ). One study in critically ill children with respiratory failure and shock demonstrated that high TFC values correlate with pulmonary plethora and predicted patient outcomes ( 37 ). Another study in patients with heart failure suggested that TFC may identify patients at risk for decompensation ( 38 ).…”

Tools for assessing lung fluid in neonates with respiratory distress

“…The pro-inflammatory cytokine, such as tumor necrosis factor (TNF), has been shown to contribute to the development of pulmonary edema and alveolar fluid reabsorption [ 9 ]. In addition, thoracic fluid content (TFC) using electric cardiometry has been postulated to provide an estimation of extravascular lung fluid [ 10 ], and TFC correlated well with extravascular lung fluid. TFC could be a useful tool for detecting pulmonary edema in mothers with pre-eclampsia and for diagnosing weaning failure in cardiac patients [ 10 ].…”

“…In addition, thoracic fluid content (TFC) using electric cardiometry has been postulated to provide an estimation of extravascular lung fluid [ 10 ], and TFC correlated well with extravascular lung fluid. TFC could be a useful tool for detecting pulmonary edema in mothers with pre-eclampsia and for diagnosing weaning failure in cardiac patients [ 10 ]. However, only a few studies have assessed lung fluid in neonates.…”