Role of Stress-induced Diastolic Dysfunction in Weaning Failure from Mechanical Ventilation
DOI:
https://doi.org/10.3889/oamjms.2022.9612Keywords:
Mechanical ventilation, Weaning, Dobutamine echo, Diastolic dysfunctionAbstract
- Introduction: Critically ill patients may suffer varying degrees of myocardial dysfunction which can cause weaning failure. Stress echocardiography may be helpful in detecting silent diastolic dysfunction (DD) while weaning off mechanical ventilation [1].
- Objectives: assess the existence of temporary DD during respiratory weaning using stress echocardiography.
- Methods: Our study was conducted on 60 ventilated patients admitted to the department of critical care, Cairo University. Stress echocardiography was done using dobutamine to assess DD and pulmonary capillary wedge pressure using E/e′ ratio.
- Results: a total of 34 patients (56.66%) was successfully weaned of mechanical ventilation 26 patients (43.3%) had failed weaning of mechanical ventilation. Patients with successful weaning had no statistically significant difference regarding the E/e\ ratio before and after stress testing (P value: <0.001). While patients with failed weaning had statistically significant difference regarding the E/e\ with a mean E/e\ ratio of 11.11 ± 4.44 after stress testing vs. 6.5 ±1.39 before stress testing, (P value was <0.001).
- Conclusion: Diastolic dysfunction is a predisposing factor for weaning failure. In addition, stress echocardiography can detect silent diastolic dysfunction during respiratory weaning.
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Hu K, Liu D, Herrmann S, Niemann M, Gaudron PD, Voelker W, et al. Clinical implication of mitral annular plane systolic excursion for patients with cardiovascular disease. Eur Heart J Cardiovasc Imaging. 2013;14(3):205-12. https://doi.org/10.1093/ehjci/jes240 PMid:23161791
Soni N, Williams P. Positive pressure ventilation: What is the real cost? Br J Anaesth. 2008;101(4):446-57. https://doi.org/10.1093/bja/aen240
McConville JF, Kress JP. Weaning patients from the ventilator. N Engl J Med. 2013;367(23):2233-9. https://doi.org/10.1056/NEJMra1203367 PMid:23215559
Epstein SK, Nevins ML, Chung J. Effect of unplanned extubation on outcome of mechanical ventilation. Am J Respir Crit Care Med. 2000;161(6):1912-6. https://doi.org/10.1164/ajrccm.161.6.9908068 PMid:10852766
Kite-Powell DM. Rapid Shallow Breathing Index and Weaning Outcome in Cardiovascular Surgery Patients Requiring Mechanical Ventilation for 24 Hours or Longer. Denton: Texas Woman’s University; 2008.
Heunks LM, Van Der Hoeven JG. Clinical review: The ABC of weaning failure-a structured approach. Crit Care. 2010;14(6):245. https://doi.org/10.1186/cc9296 PMid:21143773
Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguía C, González M, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med. 2004,350(24):2452-60. https://doi.org/10.1056/NEJMoa032736 PMid:15190137
Palkar A, Mayo P, Singh K, Koenig S, Narasimhan M, Singh A, et al. Serial diaphragm ultrasonography to predict successful discontinuation of mechanical ventilation. Lung. 2018;196(3):363-8. https://doi.org/10.1007/s00408-018-0106-x PMid:29556805
Lamia B, Maizel J, Ochagavia A, Chemla D, Osman D, Richard C, et al. Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation. Crit Care Med. 2009;37(5):1696-701. https://doi.org/10.1097/CCM.0b013e31819f13d0 PMid:19325473
Ruiz-Bailén M, Cobo-Molinos J, Castillo-Rivera A, Pola- Gallego-de-Guzmán MD, Cárdenas-Cruz A, Martínez-Amat A, et al. Stress echocardiography in patients who experienced mechanical ventilation weaning failure. J Crit Care. 2017;39:66-71. https://doi.org/10.1016/j.jcrc.2017.01.004 PMid:28219811
Picard MH, Davidoff R, Sleeper LA, Mendes LA, Thompson CR, Dzavik V, et al. Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock. Circulation. 2003;107(2):279-84. https://doi.org/10.1161/01.cir.0000045667.11911.f6 PMid:12538428
Reynolds HR, Anand SK, Fox JM, Harkness S, Dzavik V, White HD, et al. Restrictive physiology in cardiogenic shock: Observations from echocardiography. Am Heart J. 2006;151(4):890-e9-15. https://doi.org/10.1016/j.ahj.2005.08.020 PMid:16569556
Slama M, Maizel J. Echocardiographic measurement of ventricular function. Curr Opin Crit Care. 2006;12(3):241-8. https://doi.org/10.1097/01.ccx.0000224869.86205.1a PMid:16672784
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009;10(2):165-93. https://doi.org/10.1093/ejechocard/jep007 PMid:19270053
Chan YH. Biostatistics102: Quantitative data-parametric and nonparametric tests. Singapore Med J. 2003;44(8):391-6. PMid:14700417
Chan YH. Biostatistics 103: Qualitative data-tests of independence. Singapore Med J. 2003;44(10):498-503. PMid:15024452
Richard C, Teboul JL. Weaning failure from cardiovascular origin. Intensive Care Med. 2005;31(12):1605-7. https://doi.org/10.1007/s00134-005-2698-x PMid:16247625
Severo M, Gaio AR, Lourenço P, Alvelos M, Gonçalves A, Lunet N, et al. Diagnostic value of patterns of symptoms and signs of heart failure: Application of latent class analysis with concomitant variables in a cross-sectional study. BMJ Open. 2012;2(6):e001510. https://doi.org/10.1136/bmjopen-2012-001510 PMid:23148342
Ruiz-Bailén M, Romero-Bermejo FJ, Rucabado-Aguilar L, Pérez-Valenzuela J, Ferrezuelo-Mata Á, Ramírez-Sánchez M, et al. Myocardial dysfunction in the critically ill patient: Is it really reversible? Int J Cardiol. 2010;145(3):615-6. https://doi.org/10.1016/j.ijcard.2010.09.032 PMid:20937534
Ballester-Rodés M, Flotats A, Torrent-Guasp F, Carrió- Gasset I, Ballester-Alomar M, Carreras F, et al. The sequence of regional ventricular motion. Eur J Cardiothorac Surg. 2006;29(Suppl 1):S139-44. https://doi.org/10.1016/j.ejcts.2006.02.058 PMid:16564179
El-Dehily K, El-Maraghi S, Soliman R, Khaled H. Tricusped annular plane systolic excursion and right ventricular tissue Doppler imaging as indicator of weaning failure in mechanically ventilated patients. Egypt J Intensive Care Trauma. 2017; 20(1):369-369.
Moschietto S, Doyen D, Grech L, Dellamonica J, Hyvernat H, Bernardin G. Transthoracic echocardiography with Doppler tissue imaging predicts weaning failure from mechanical ventilation: Evolution of the left ventricle relaxation rate during a spontaneous breathing trial is the key factor in weaning outcome. Crit Care. 2012;16(3):R81. https://doi.org/10.1186/cc11339 PMid:22583512
Roche-Campo F, Bedet A, Vivier E, Brochard L, Dessap AM. Cardiac function during weaning failure: The role of diastolic dysfunction. Ann Intensive Care. 2018;8(1):2. https://doi.org/10.1186/s13613-017-0348-4 PMid:29330683
Daif MS, Khalil MM, Salem HM, Moteleb AM, Abd-Elhamid HE. Using echocardiography and chest ultrasound for guidance of management of difficult-to wean COPD patients. J Cardiol Curr Res. 2018;11(4):178-4.
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Copyright (c) 2022 Mostafa Rafea, Karim Mashhour, Mohamed Fawzy, Hanan Zaghla, Sherin El-Gengihi (Author)
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