Critical Care and Shock

Role of cumulative fluid balance, intraabdominal pressure, diaphragm excursion, and neutrophil-lymphocyte ratio on the difficulty of the weaning process from mechanical ventilation in critically ill patients

Abstract

Objective: The weaning process of mechanical ventilation in critically ill patients could face resistance from multifactorial causes and about 30% become difficult in the weaning process, which lead to many other complications. As the consequences of Surviving Sepsis Campaign Guidelines for septic shock patients, there would be fluid accumulation in intensive care unit (ICU) patients resulting in positive cumulative fluid balance. Movement of the diaphragm muscle as the main respiratory muscle could be restricted by high intraabdominal pressure. The measurement of intraabdominal pressure has not been a routine examination in ICU and so diaphragm movement and excursion. Ongoing infection also contributed to the difficulty in the weaning process of mechanical ventilation. The aim of this study was to find whether the weaning process of mechanical ventilation was influenced by cumulative fluid balance, intraabdominal pressure, diaphragm excursion, and neutrophil-lymphocyte ratio.

Design: This study was an analytic observational study with a prospective cohort design.

Setting: Intensive Care Unit of Cipto Mangunkusumo National General Hospital Jakarta, Indonesia.

Patients and participants: The subjects of this study were 30 mechanically ventilated patients in the ICU from November to December 2020.

Interventions: Cumulative fluid balance, intraabdominal pressure, diaphragm excursion, and neutrophil-lymphocyte ratio were initially documented on the first 24 hours on mechanical ventilation and be compared when the ventilator mode was pressure support £8 or using T-piece until 7 days maximum or until day 7 if the patients could not be weaned.

Measurements and results: Demographics and clinical characteristics were evaluated. The relationship between cumulative fluid balance and the weaning process from mechanical ventilation was not significant (p=0.243; odds ratio [OR] 1.257; confidence interval [CI] 95% 0.787-2.007). The relationship between intraabdominal pressure and the weaning process from mechanical ventilation was not significant (p=0.550; OR 1.14; CI 95% 0.691-1.891). The relationship between diaphragm excursion and the weaning process from mechanical ventilation was not significant (p=0.053; OR 1.4; CI 95% 0.321-6.109). The relationship between neutrophil-lymphocyte ratio and the weaning process from mechanical ventilation was not significant (p=0.259; OR 1.33; CI 95% 0.586-3.03).

Conclusion: Cumulative fluid balance, intraabdominal pressure, diaphragm excursion, and neutrophil-lymphocyte ratio did not affect the difficulty in the weaning process from mechanical ventilation in critically ill patients in this study.