This observational study showed the pulmonary edema (WiPO) occurred in a significant number of critically ill patients who failed a first spontaneous breathing trial (SBT), while cardiac ischemia (WiCI) was less frequent.

The correlation between WiPO and WiCI was weak, and their association with weaning outcomes was weak in this non-blinded observational series.

A total of 1,749 mechanically ventilated patients were screened for the study.

Patients were explored during a second SBT using multiple tools (echocardiography, continuous 12-lead ST monitoring, biomarkers) to scrutinize the mechanisms of weaning failure.

Among patients who failed a first SBT, WiPO occurred in 124/208 (59.6%) and 44/208 (21.2%) patients, according to the liberal and conservative definition, respectively.

Among patients with ST monitoring, WiCI was diagnosed in 36/177 (20.3%) and 12/177 (6.8%) of them, according to the ESC and AHA definitions, respectively.

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