title: Increase in plasma protein concentration for diagnosing weaning-induced pulmonary oedema.
abstract: OBJECTIVE
  Weaning-induced cardiogenic pulmonary oedema is a cause of weaning failure that is classically diagnosed by an increase in pulmonary artery occlusion pressure during a spontaneous breathing trial. During cardiogenic pulmonary oedema, a hypo-oncotic fluid is filtered toward the interstitial space. Thus, we tested whether the changes in plasma protein concentration during a weaning trial could diagnose weaning-induced pulmonary oedema.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  The 24-bed medical intensive care unit of a university hospital.
  
  
  METHODS
  Forty-six patients who had failed two weaning trials.
  
  
  METHODS
  Weaning-induced pulmonary oedema was diagnosed if a respiratory failure associated with an increase in pulmonary artery occlusion pressure above 18 mmHg occurred during a third weaning trial on a T-tube. The plasma protein concentration was measured before and at the end of the spontaneous breathing trial.
  
  
  RESULTS
  During the weaning trial, pulmonary oedema was observed in 24 patients. In these patients, the plasma protein concentration increased by 11% (3-25%). The plasma protein concentration did not change significantly in patients who did not experience weaning-induced pulmonary oedema. An increase in the plasma protein concentration greater than 6% from baseline to the end of the weaning trial allowed detecting a weaning-induced pulmonary oedema with a sensitivity of 87% and a specificity of 95%.
  
  
  CONCLUSIONS
  The acute changes in plasma protein concentration during a weaning trial represent an alternative method to right heart catheterisation for assessing weaning-induced pulmonary oedema.
authors.affiliation: Service de réanimation médicale, Centre Hospitalier Universitaire de Bicêtre, AP-HP, 94 270, Le Kremlin-Bicêtre, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Anguel
authors.forename: Xavier
authors.initials: X
authors.lastname: Monnet
authors.forename: David
authors.initials: D
authors.lastname: Osman
authors.forename: Vincent
authors.initials: V
authors.lastname: Castelain
authors.forename: Christian
authors.initials: C
authors.lastname: Richard
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Teboul
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001798:Blood Proteins / Q000378:metabolism*; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D011654:Pulmonary Edema / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D012372:ROC Curve; D015300:Ventilator Weaning / Q000009:adverse effects*
chemical_list: D001798:Blood Proteins