Increase in plasma protein concentration for diagnosing weaning-induced pulmonary oedema.
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.
Anguel
Nadia
N
Service de réanimation médicale, Centre Hospitalier Universitaire de Bicêtre, AP-HP, 94 270, Le Kremlin-Bicêtre, France.
Monnet
Xavier
X
Osman
David
D
Castelain
Vincent
V
Richard
Christian
C
Teboul
Jean-Louis
JL
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*
D001798:Blood Proteins