目的:评估舒张功能障碍和液体平衡在断奶失败中的作用。
方法:前瞻性,观察,单中心。
方法:大学医院的重症监护病房。
方法:接受自主呼吸试验(SBT)的机械通气超过48小时的成年患者。
方法:在SBT之前和结束时立即进行超声心动图检查。根据断奶结局将患者分为两组。
■断奶失败。
结果:在89名患者中,33例(37%)患者出现断奶失败.SBT结束时孤立的舒张功能障碍在失败组中更为常见(39.3%vs.17.8%,p=0.025)。失败的患者从ICU入院到第一次SBT的平均每日液体平衡比断奶成功的患者低(-648mL[-884至-138]vs.-893毫升[-1284至-501],p=0.007)。从第一次SBT到ICU出院的平均每日液体平衡在断奶失败中比在成功组中更负(-973mL[-1493至-201]vs.-425毫升[-1065至12],p=0.034)。Cox回归分析显示,舒张功能障碍不是断奶失败的独立因素,而是需要体液平衡阳性和年龄的关联。
结论:舒张功能障碍导致的断奶失败与液体平衡高度相关,液体平衡对舒张功能的有害影响与年龄有关。在这种情况下,液体清除的时机可能起关键作用。
To assess the role of diastolic dysfunction and fluid balance in weaning failure.
Prospective, observational, single center.
Intensive care unit of a university hospital.
Adult patients on mechanical ventilation for more than 48 h who underwent a spontaneous breathing trial (SBT).
Echocardiography was performed immediately before and at the end of SBT. Patients were classified into two groups according to weaning outcome.
Weaning failure.
Among 89 patients included, weaning failure occurred in 33 patients (37%). Isolated diastolic dysfunction at the end of the SBT was more frequent in the failure group (39.3% vs. 17.8%, p = 0.025). Average daily fluid balance from ICU admission until first SBT was less negative in patients who failed than in those who succeed in the weaning (-648 mL [-884 to -138] vs. -893 mL [-1284 to -501], p = 0.007). Average daily fluid balance from the first SBT until the ICU discharge was more negative in the weaning failure than in the success group (-973 mL [-1493 to -201] vs. -425 mL [-1065 to 12], p = 0.034). Cox regression analysis showed that diastolic dysfunction was not an independent factor related to weaning failure but needed the association of positive fluid balance and age.
Weaning failure due to diastolic dysfunction is highly related to fluid balance, and the deleterious effect of fluid balance on diastolic function is associated with age The timing of fluid removal could play a key role in this scenario.