Τίτλος:
Weaning Failure in Critically Ill Patients Is Related to the Persistence
of Sepsis Inflammation
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Kyriakoudi, Anna
Rovina, Nikoletta
Koltsida, Ourania and
Kostakou, Eirini
Konstantelou, Elissavet
Kardara, Matina and
Kompoti, Maria
Palamidas, Anastasios
Kaltsakas, Georgios and
Koutsoukou, Antonia
Περιοδικό:
DIAGNOSTIC ONCOLOGY
Λέξεις-κλειδιά:
sepsis; inflammation; IL-18; IL-18BP; critically ill patients
DOI:
10.3390/diagnostics12010092
