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Observational Study
. 2025 Mar 31;29(1):140.
doi: 10.1186/s13054-025-05350-6.

Incidence and risk factors of weaning-induced pulmonary oedema: results from a multicentre, observational study

Rui Shi  1   2   3 , Soufia Ayed  4 , Marion Beuzelin  5 , Romain Persichini  6 , Marie Legouge  7 , Nello D E Vita  8 , Bruno Levy  9 , Alexandra Beurton  10 , Kishore Mangal  11 , Thomas Hullin  12 , Vincent Labbe  13 , Max Guillot  14 , Anatole Harrois  15 , Maurizio Cecconi  16   17 , Nadia Anguel  4   18 , David Osman  4 , Francesca Moretto  4   18 , Christopher Lai  4   18 , Tài Pham  4   18   19 , Jean-Louis Teboul  4   18 , Xavier Monnet  4   18
Affiliations
Observational Study

Incidence and risk factors of weaning-induced pulmonary oedema: results from a multicentre, observational study

Rui Shi et al. Crit Care. .

Abstract

Background: During the weaning process, the transition from positive to negative pressure ventilation may induce cardiac dysfunction, which may lead to pulmonary oedema. The incidence of weaning-induced pulmonary oedema (WIPO) is poorly documented and shows huge variations. Our study aims to investigate the incidence and risk factors for WIPO during weaning from mechanical ventilation in general critically ill patients.

Methods: This multicentre study was conducted in France, Italy, and India. Adult critically ill patients receiving invasive ventilation were included once a spontaneous breathing trial (SBT) was performed. The SBT technique could be either T-piece or pressure support mode with (PSV-PEEP) or without positive end expiratory pressure (PEEP) (PSV-ZEEP). A consensual diagnosis of WIPO was made a posteriori by five experts who analysed changes observed during the SBT that were retrospectively recorded.

Results: From July 2019 to February 2021, 634 SBTs were performed in 500 patients from 13 ICUs. Weaning success occurred in 417 patients (66%) and weaning failure in 217 (34%). Weaning was short in 414 (83%) of SBTs, difficult in 47 (9%) SBTs, and prolonged in 39 (8%) SBTs. WIPO was diagnosed in 79 (12%) cases, which accounted for 36% of the 217 weaning failures. WIPO occurred in 54/358 (15%) of T-piece SBT, in 7/84 (8%) of PSV-PEEP SBT (p = 0.072 vs. T-piece), and in 18/192 (9%) of PSV-ZEEP SBT (p = 0.002 vs. T-piece). In multilevel logistic regression analysis including 202 weaning failures from 149 different patients, COPD, and previous cardiomyopathy were identified as independent risk factors associated with WIPO.

Conclusion: In general ICU patients, WIPO accounts for 36% of weaning failure cases. Previous heart disease and COPD are two independent risk factors for developing WIPO during the weaning process.

Clinicaltrials: gov identifier (retrospectively registered on 2022-03-31): NCT05318261.

Keywords: COPD; Heart–lung interaction; Spontaneous breathing trial; Weaning.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The trial protocol was approved by the ethics committee of the French Intensive Care Society (2017-A00392-51) and registered on ClinicalTrials (NCT05318261). Informed consent was obtained from each patient or from the patient’s legally authorized representative if the patient was unable to provide consent. Alternatively, deferred informed consent was obtained from patients. The current study was performed in accordance with French law and the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Incidence of failure of the spontaneous breathing trial (SBT) and weaning-induced pulmonary oedema (WIPO). N = 500 patients
Fig. 2
Fig. 2
Incidence of failure of the spontaneous breathing trial (SBT) and weaning-induced pulmonary oedema (WIPO) in patients with chronic obstructive pulmonary disease (COPD) and patients with previous cardiomyopathy. N = 500 patients
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Comment in

References

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