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Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation
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:...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8774440/ https://www.ncbi.nlm.nih.gov/pubmed/35054259 http://dx.doi.org/10.3390/diagnostics12010092 |
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author | Kyriakoudi, Anna Rovina, Nikoletta Koltsida, Ourania Kostakou, Eirini Konstantelou, Elissavet Kardara, Matina Kompoti, Maria Palamidas, Anastasios Kaltsakas, Georgios Koutsoukou, Antonia |
author_facet | Kyriakoudi, Anna Rovina, Nikoletta Koltsida, Ourania Kostakou, Eirini Konstantelou, Elissavet Kardara, Matina Kompoti, Maria Palamidas, Anastasios Kaltsakas, Georgios Koutsoukou, Antonia |
author_sort | Kyriakoudi, Anna |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8774440 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-87744402022-01-21 Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation Kyriakoudi, Anna Rovina, Nikoletta Koltsida, Ourania Kostakou, Eirini Konstantelou, Elissavet Kardara, Matina Kompoti, Maria Palamidas, Anastasios Kaltsakas, Georgios Koutsoukou, Antonia Diagnostics (Basel) Article 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. MDPI 2021-12-31 /pmc/articles/PMC8774440/ /pubmed/35054259 http://dx.doi.org/10.3390/diagnostics12010092 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Kyriakoudi, Anna Rovina, Nikoletta Koltsida, Ourania Kostakou, Eirini Konstantelou, Elissavet Kardara, Matina Kompoti, Maria Palamidas, Anastasios Kaltsakas, Georgios Koutsoukou, Antonia Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation |
title | Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation |
title_full | Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation |
title_fullStr | Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation |
title_full_unstemmed | Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation |
title_short | Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation |
title_sort | weaning failure in critically ill patients is related to the persistence of sepsis inflammation |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8774440/ https://www.ncbi.nlm.nih.gov/pubmed/35054259 http://dx.doi.org/10.3390/diagnostics12010092 |
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