SGLT2 Inhibitors in Patients With ADHF During Ventilator Weaning

Inclusion criteria

• Patients aged ≥20 years
• Currently hospitalized for the primary diagnosis of acute HF (de novo or decompensated chronic HF) in HFrEF patients (LVEF≤40%)
• Meet the stabilization criteria:
• A. Systolic BP ≥100mm Hg and no symptoms of hypotension in the preceding 6 hours B. No increase in i.v. diuretic dose for 6 hours prior to randomization C. No i.v. vasodilators including nitrates within the last 6 hours prior to randomization D. No i.v. inotropic drugs for 24 hours prior to randomization
• Elevated N-terminal proB-type natriuretic peptide (NT-proBNP) or BNP:
• A. Without atrial fibrillation (AF): NT-proBNP ≥1600 pg/mL or BNP ≥400 pg/mL B. With AF: NT-proBNP ≥2400 pg/mL or BNP ≥600 pg/mL
• Patients were intubated for at least 24 hour with ventilator settings allowing to initiate the weaning process \[SpO2 \> 90% or PaO2/FiO2 ≥ 150 mmHg with a fraction of inspired oxygen (FiO2) ≤ 40% and a positive end-expiratory pressure (PEEP) ≤ 8 cmH2O\].

Exclusion criteria

• Decision to withdraw life support
• Cardiogenic shock
• Hospitalization for HF (HHF) triggered by acute myocardial infarction (AMI) or pulmonary embolism
• Planned or previous (within 30 days) cardiovascular revascularization or major cardiac surgery/intervention/device implantation
• Prior acute coronary syndrome, AMI, stroke or transient ischemic accident within 90 days
• Estimated glomerular filtration rate (eGFR) of less than 30 ml per minute per 1.73 m2 of body-surface area
• Type 1 diabetes mellitus
• Poorly controlled type 2 diabetes mellitus (a glycated hemoglobin level above 10.5%)
• Uncontrolled urinary tract infection