Pleural effusion during weaning from mechanical ventilation: a prospective observational multicenter study.

Area of Science:

• Critical Care Medicine
• Pulmonology
• Medical Imaging

Background:

• Pleural effusion is a frequent complication during invasive mechanical ventilation.
• The impact of pleural effusion on the weaning process from mechanical ventilation remains unclear.
• Understanding pleural effusion's role is crucial for improving patient outcomes during weaning.

Purpose of the Study:

• To determine the prevalence of pleural effusion at the start of weaning.
• To identify risk factors associated with pleural effusion during weaning.
• To evaluate the impact of pleural effusion on weaning outcomes and its progression in difficult weaning cases.

Main Methods:

• A prospective, multicenter study was conducted in five French intensive care units.
• Ultrasonography was used to assess 249 patients for moderate-to-large pleural effusion (interpleural distance ≥ 15 mm) at weaning initiation and during difficult weaning.
• Weaning outcomes, including spontaneous breathing trial (SBT) success, extubation, ventilator-free days, and mortality, were recorded.

Main Results:

• Moderate-to-large pleural effusion was present in 33% of patients at weaning start.
• Patients with pleural effusion experienced significantly more SBT failures (33% vs. 11%) and overall weaning failures (47% vs. 22%).
• Pleural effusion was associated with fewer ventilator-free days and higher 28-day mortality, independent of other factors.

Conclusions:

• Pleural effusion is a common finding during the mechanical ventilation weaning process.
• The presence of pleural effusion is significantly associated with adverse weaning outcomes, including higher failure rates and mortality.
• Further research may explore targeted interventions for pleural effusion to improve weaning success.