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

Anna Kyriakoudi1, Nikoletta Rovina1, Ourania Koltsida1

  • 11st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and "Sotiria" Chest Disease Hospital, 11527 Athens, Greece.

Diagnostics (Basel, Switzerland)
|January 21, 2022
PubMed
Abstract

Insights

Sepsis patients on mechanical ventilation have higher rates of spontaneous breathing trial (SBT) failure. Inflammatory markers like IL-18 and IL-18BP indicate a higher risk of weaning failure in these critically ill patients.

Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Infectious Disease

Background:

  • Mechanical ventilation (MV) poses weaning challenges for septic patients.
  • Identifying predictors of weaning success is crucial for patient recovery.

Purpose of the Study:

  • To investigate inflammatory biomarkers of sepsis as predictors of spontaneous breathing trial (SBT) success or failure.
  • To assess the role of serum inflammatory mediators in weaning outcomes for ventilated patients.

Main Methods:

  • Sixty-five patients on MV (42 septic, 23 non-septic) underwent SBT.
  • Serum samples were collected pre-SBT, post-SBT (30 min), and 24 hours after SBT.
  • Levels of Interleukin-18 (IL-18), IL-18 Binding Protein (IL-18BP), and Tumor Necrosis Factor (TNF) were measured and correlated with SBT outcomes.

Main Results:

  • Septic patients exhibited a significantly higher SBT failure rate (85%) compared to non-septic patients (15%).
  • Elevated serum IL-18 and TNF levels were independently associated with sepsis.
  • Higher IL-18 and IL-18BP levels were indicative of SBT failure, with IL-18BP negatively associated with the rapid shallow breathing index (RSBI).

Conclusions:

  • Sustained elevated IL-18 and IL-18BP levels predict SBT failure in sepsis survivors.
  • Persistent subclinical inflammation in sepsis complicates weaning from mechanical ventilation.
  • There is a need for biomarkers to accurately estimate septic burden and determine optimal weaning timing.
Keywords:
IL-18IL-18BPcritically ill patientsinflammationsepsis

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