Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation.

Autor: Kyriakoudi A; 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and 'Sotiria' Chest Disease Hospital, 11527 Athens, Greece., Rovina N; 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and 'Sotiria' Chest Disease Hospital, 11527 Athens, Greece., Koltsida O; 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and 'Sotiria' Chest Disease Hospital, 11527 Athens, Greece., Kostakou E; 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and 'Sotiria' Chest Disease Hospital, 11527 Athens, Greece., Konstantelou E; 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and 'Sotiria' Chest Disease Hospital, 11527 Athens, Greece., Kardara M; 1st Department of Critical Care Medicine & Pulmonary Services, National and Kapodistrian University of Athens, Medical School, Evangelismos Hospital, 10676 Athens, Greece., Kompoti M; Intensive Care Unit, General Hospital of Eleusis Thriasio, 13674 Athens, Greece., Palamidas A; 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and 'Sotiria' Chest Disease Hospital, 11527 Athens, Greece., Kaltsakas G; 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and 'Sotiria' Chest Disease Hospital, 11527 Athens, Greece., Koutsoukou A; 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and 'Sotiria' Chest Disease Hospital, 11527 Athens, Greece.
Jazyk: angličtina
Zdroj: Diagnostics (Basel, Switzerland) [Diagnostics (Basel)] 2021 Dec 31; Vol. 12 (1). Date of Electronic Publication: 2021 Dec 31.
DOI: 10.3390/diagnostics12010092
Abstrakt: Introduction: Septic patients undergoing mechanical ventilation (MV) often experience difficulty in weaning. Th aim of this study was to determine whether inflammatory biomarkers of sepsis could be indicative of the failure or success of spontaneous breathing trial (SBT) in these patients.
Methods: Sixty-five patients on MV (42 septic and 23 intubated for other reasons) fulfilling the criteria for SBT were included in the study. Blood samples were collected right before, at the end of (30 min) and 24 h after the SBT. Serum inflammatory mediators associated with sepsis (IL-18, IL-18BP, TNF) were determined and correlated with the outcome of SBT.
Results: A successful SBT was achieved in 45 patients (69.2%). Septic patients had a higher percentage of SBT failure as compared to non-septic patients (85% vs. 15%, p = 0.026), with an odds ratio for failing 4.5 times (OR = 4.5 95%CI: 1.16-17.68, p 0.022). IL-18 levels and the relative mRNA expression in serum were significantly higher in septic as compared to non-septic patients ( p < 0.05). Sepsis was independently associated with higher serum IL-18 and TNF levels in two time-point GEE models (53-723, p = 0.023 and 0.3-64, p = 0.048, respectively). IL-18BP displayed independent negative association with rapid shallow breathing index (RSBI) (95% CI: -17.6 to -4, p = 0.002).
Conclusion: Sustained increased levels of IL-18 and IL-18BP, acknowledged markers of sepsis, were found to be indicative of SBT failure in patients recovering from sepsis. Our results show that, although subclinical, remaining septic inflammation that sustaines for a long time complicates the weaning procedure. Biomarkers for the estimation of the septic burden and the right time for weaning are needed.
Databáze: MEDLINE
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