Newly Published
Critical Care Medicine  |   March 2017
Prevalence and Impact on Weaning of Pleural Effusion at the Time of Liberation from Mechanical Ventilation: A Multicenter Prospective Observational Study
Author Notes
  • From the UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie–Université Paris 06, INSERM, Paris, France (M.D., A.D.); Service de Pneumologie et Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France (M.D., A.B., A.D.); IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité Paris, France (D.R., J.-D.R.); Service de Réanimation Médico-chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Colombes, France (D.R., J.-D.R.); Service de Réanimation Médico-chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Groupe Hospitalier des Hôpitaux Universitaires de l’Est Parisien, Paris, France (T.P., M.F.); and Sorbonne Universités, Université Pierre et Marie Curie–Université Paris 06, Paris, France (T.P., M.F.).
  • Submitted for publication July 3, 2016. Accepted for publication February 20, 2017.
    Submitted for publication July 3, 2016. Accepted for publication February 20, 2017.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Research Support: Supported by the French Intensive Care Society (Paris, France) Mobility Exchange 2015, the 2015 Short Term Fellowship program of the European Respiratory Society (Lausanne, Switzerland), the 2015 Bernhard Dräger Award for advanced treatment of acute respiratory failure of the European Society of Intensive Care Medicine (Brussels, Belgium), the Assistance Publique Hôpitaux de Paris (Paris, France), and Fondation pour la Recherche Médicale (Paris, France) grant No. FDM 20150734498 (to Dr. Dres).
    Research Support: Supported by the French Intensive Care Society (Paris, France) Mobility Exchange 2015, the 2015 Short Term Fellowship program of the European Respiratory Society (Lausanne, Switzerland), the 2015 Bernhard Dräger Award for advanced treatment of acute respiratory failure of the European Society of Intensive Care Medicine (Brussels, Belgium), the Assistance Publique Hôpitaux de Paris (Paris, France), and Fondation pour la Recherche Médicale (Paris, France) grant No. FDM 20150734498 (to Dr. Dres).×
  • Competing Interests: Dr. Demoule has signed research contracts with Covidien (Dublin, Ireland), Maquet (Rastatt, Germany), and Philips (Amsterdam, The Netherland) and has also received personal fees from Covidien (Dublin, Ireland), Maquet (Rastatt, Germany), and MSD (Courbevoie, France). Dr. Dres received personal fees from Pulsion Medical System (Feldkirchen, Germany) and Astra Zeneca (Cambridge, UK). Dr. Ricard received travel expenses from Fisher & Paykel (Kingston, Milton Keynes, UK) to attend scientific meetings. Dr. Roux received personal fees from Astellas (Levallois-Perret, France). The other authors declare no competing interests.
    Competing Interests: Dr. Demoule has signed research contracts with Covidien (Dublin, Ireland), Maquet (Rastatt, Germany), and Philips (Amsterdam, The Netherland) and has also received personal fees from Covidien (Dublin, Ireland), Maquet (Rastatt, Germany), and MSD (Courbevoie, France). Dr. Dres received personal fees from Pulsion Medical System (Feldkirchen, Germany) and Astra Zeneca (Cambridge, UK). Dr. Ricard received travel expenses from Fisher & Paykel (Kingston, Milton Keynes, UK) to attend scientific meetings. Dr. Roux received personal fees from Astellas (Levallois-Perret, France). The other authors declare no competing interests.×
  • Correspondence: Address correspondence to: Martin Dres, M.D., Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, 47–83 Boulevard de l’Hôpital, 75651 Paris Cedex 13, France. martin.dres@aphp.fr. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Critical Care Medicine / Critical Care / Respiratory System
Critical Care Medicine   |   March 2017
Prevalence and Impact on Weaning of Pleural Effusion at the Time of Liberation from Mechanical Ventilation: A Multicenter Prospective Observational Study
Anesthesiology Newly Published on March 30, 2017. doi:10.1097/ALN.0000000000001621
Anesthesiology Newly Published on March 30, 2017. doi:10.1097/ALN.0000000000001621
Abstract

Background: Pleural effusion is frequent in intensive care unit patients, but its impact on the outcome of weaning remains unknown.

Methods: In a prospective study performed in three intensive care units, pleural ultrasound was performed at the first spontaneous breathing trial to detect and quantify pleural effusion (small, moderate, and large). Weaning failure was defined by a failed spontaneous breathing trial and/or extubation requiring any form of ventilatory support within 48 h. The primary endpoint was the prevalence of pleural effusion according to weaning outcome.

Results: Pleural effusion was detected in 51 of 136 (37%) patients and was quantified as moderate to large in 18 (13%) patients. As compared to patients with no or small pleural effusion, their counterparts were more likely to have chronic renal failure (39 vs. 7%; P = 0.01), shock as the primary reason for admission (44 vs. 19%; P = 0.02), and a greater weight gain (+4 [0 to 7] kg vs. 0 [−1 to 5] kg; P = 0.02). The prevalence of pleural effusion was similar in weaning success and weaning failure patients (odds ratio, 1.23; 95% CI, 0.61 to 2.49; P = 0.56), as was the prevalence of moderate to large pleural effusion (odds ratio, 0.89; 95% CI, 0.33 to 2.41; P = 1.00). Duration of mechanical ventilation and intensive care unit length of stay were similar between patients with no or small pleural effusion and those with moderate to large pleural effusion.

Conclusions: Significant pleural effusion was observed in 13% of patients at the time of liberation from mechanical ventilation and was not associated with an alteration of weaning outcome.