ABSTRACT
INTRODUCTION: The concept of weaning-induced cardiac dysfunction emerged 26 years ago with the publication of a clinical study conducted by François Lemaire and collaborators. OBJECTIVES: One objective of this article is to remember the results and the historical context under which our pivotal study was conducted. Another objective is to review some of the subsequent studies that aimed to analyze the underlying mechanisms, to noninvasively detect the cardiac origin of weaning failure, and to propose specific therapies enabling weaning success. CONCLUSION: Weaning-induced cardiac dysfunction has become an established cause of weaning failure. Underlying mechanisms may differ from one patient to another. Important progress has already been made in its diagnosis thanks to relevant clinical research studies. Ongoing and future technological advances in ultrasonography and in biomarker research should certainly help in diagnosing weaning induced-pulmonary edema and in identifying the main mechanisms responsible for its development. Progress on appropriate therapeutic options on an individual basis is still expected.
Subject(s)
Heart Diseases/etiology , Ventilator Weaning/adverse effects , Aged , France , Heart Diseases/history , Heart Diseases/physiopathology , Heart Diseases/prevention & control , Heart Diseases/therapy , History, 20th Century , Humans , Ventilator Weaning/historyABSTRACT
The approach to ventilator weaning has changed considerably over the past 30 years. Change has resulted from research in three areas: pathophysiology, weaning-predictor testing, and weaning techniques. Physiology research illuminated the mechanisms of weaning failure. It also uncovered markers of weaning success. Through more reliable prediction, patients whose weaning would have been tedious in the 1970s are now weaned more rapidly. The weaning story offers several lessons in metascience: importance of creativity, the asking of heretical questions, serendipity, mental-set psychology, cross-fertilization, and the hazards of precocity. Weaning research also illustrates how Kuhnian normal (me-too) science dominates any field. Making the next quantum leap in weaning will depend on spending less time on normal science and more on the raising (and testing) of maverick ideas.
