Association between respiratory-related cortical activation and weaning from
mechanical ventilation: a physiological study
#MMPMID41184870
Rault CCS
; Thille AW
; Héraud Q
; Ragot S
; Coudroy R
; Frat JP
; Drouot X
Crit Care
2025[Nov]; 29
(1
): 467
PMID41184870
show ga
BACKGROUND: In mechanically ventilated patients, extubation is decided after
passing a spontaneous breathing trial (SBT). Supplementary motor area, which can
be non-invasively assessed by measuring amplitude of pre-inspiratory potentials
(PIPs), is recruited in case of increased respiratory effort. Weaning failure may
be accompanied by increased respiratory effort. We hypothesized that early
increased PIP amplitude from the start of SBT may be associated with SBT failure.
PATIENTS AND METHODS: We performed a single-center physiological prospective
study in mechanically ventilated patients meeting weaning criteria. PIP amplitude
was measured using electroencephalography under mechanical ventilation and then
during the first 15-min of the SBT performed using a T-piece. We compared
respiratory-related cortical activation between patients who passed a 1-h SBT and
those who failed. RESULTS: Among the 62 patients included, 17 (27%) failed the
SBT. Whereas patients who failed the SBT had a lower median amplitude of PIPs
under mechanical ventilation than those who passed the SBT (0.6 µV [IQR, 0-1.3]
vs. 1.9 [1.2-2.9], p?0.0001), they had a higher amplitude of PIPs at the
beginning of the SBT (2.1 µV [IQR, 1.7-2.9] vs. 1.2 [0.5-2.0], p?0.005). PIP
amplitude between mechanical ventilation and SBT significantly increased in case
of SBT failure whereas it decreased in case of SBT success (+?1.7 µV [1.2-2.1]
vs. -0.5 [-1.8-0.1], p?0.0001). An increase of PIP above 0.43 µV was associated
with SBT failure with sensitivity of 100% and specificity of 87%. CONCLUSION: The
demonstration of an association between increased respiratory-related cortical
activation and failure of the weaning trial is a physiological marker of interest
for better phenotyping of patients ready for weaning.