Spontaneous breathing trial (SBT) failure due to WIPO appears related to overloaded LV, including the worsening or development of mitral regurgitation, associated with excessive accumulated fluid balance. SBT-induced central hemodynamic changes monitored by CCE helps guiding weaning of patients at high risk of WIPO.

Since prolonged invasive mechanical ventilation is associated with increased morbidity and mortality, patients must be weaned from the ventilator as soon as possible.

Nevertheless, weaning failure rate ranges between 26 and 42%.

Spontaneous breathing trial (SBT) has been compared to a physical exercise.

The transition from positive to negative intrathoracic pressure alters unfavorably cardiac loading conditions, the net result being an abrupt increase in left ventricular (LV) filling pressures.

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