Echocardiographic evaluation during weaning from mechanical ventilation

Abstract

INTRODUCTION:Echocardiographic, electrocardiographic and other cardiorespiratory variables can change during weaning from mechanical ventilation.OBJECTIVES:To analyze changes in cardiac function, using Doppler echocardiogram, in critical patients during weaning from mechanical ventilation, using two different weaning methods: pressure support ventilation and T‐tube; and comparing patient subgroups: success vs. failure in weaning.METHODS:Randomized crossover clinical trial including patients under mechanical ventilation for more than 48 h and considered ready for weaning. Cardiorespiratory variables, oxygenation, electrocardiogram and Doppler echocardiogram findings were analyzed at baseline and after 30 min in pressure support ventilation and T‐tube. Pressure support ventilation vs. T‐tube and weaning success vs. failure were compared using ANOVA and Student's t‐test. The level of significance was p<0.05.RESULTS:Twenty‐four adult patients were evaluated. Seven patients failed at the first weaning attempt. No echocardiographic or electrocardiographic differences were observed between pressure support ventilation and T‐tube. Weaning failure patients presented increases in left atrium, intraventricular septum thickness, posterior wall thickness and diameter of left ventricle and shorter isovolumetric relaxation time. Successfully weaned patients had higher levels of oxygenation.CONCLUSION:No differences were observed between Doppler echocardiographic variables and electrocardiographic and other cardiorespiratory variables during pressure support ventilation and T‐tube. However cardiac structures were smaller, isovolumetric relaxation time was larger, and oxygenation level was greater in successfully weaned patients.

Tei Index versus Pro BNP as Predictors of Weaning Failure in Mechanically Ventilated Chronic Obstructive Pulmonary Disease Patients

“…He did not find any differences between Doppler echocardiography and cardiorespiratory variables during pressure support ventilation and T-tube. However cardiac structures were smaller, isovolumic relaxation time was larger, and oxygenation level was greater in successfully weaned patients [18]. It is probably safe to say that Doppler echocardiography has a place for assessment of weaning failure due to cardiac origin if performed routinely in the ICU.…”

Can Chest Sonography Predict and Facilitate Successful Ventilator Weaning?*

“…Recent investigations focusing on lung (4,5), diaphragm (6, 7), or cardiac (8)(9)(10)(11)(12) ultrasound and the case report of integrated lung, diaphragm, and cardiac ultrasound by Mongodi et al ( 13) presented in this issue of Critical Care Medicine highlight the potential of ultrasonography to enhance the prediction of extubation outcome and to identify treatable cardiopulmonary derangements that may allow earlier successful extubation in some patients.…”

“…Schifelbain et al (10) performed TTE in patients with no evidence of preexisting heart disease or left ventricular failure during the first 30 minutes of an SBT (PS or T-piece) and found increases in left atrial diameter, intraventricular septum thickness, posterior wall thickness, left ventricle diameter, and shorter isovolumetric relaxation time in patients who faüed weaning. Caille et al (8) performed TTE just prior and at the end of a 30-minute T-piece SBT in patients who cleared weaning.…”

Entwöhnung von der Beatmung (Weaning) - aktuelle Aspekte

“…Die Klassifikation, die auf Expertenmeinung basiert, wurde in einer großen multizentrischen Untersuchung erstmals an 2714 Patienten evaluiert [15] In einer randomisierten Crossover-Studie waren die echokardiographischen Befunde eines vergrößerten linken Vorhofs, eine Hypertrophie des intraventrikulären Septums sowie der posterioren Ventrikelwand, ein hoher linksventrikulärer enddiastolischer Durchmesser sowie eine verkürzte isometrische Relaxationszeit Prädiktoren eines Weaning-Versagens im Spontanatemversuch [16]. Neben der Echokardiographie kann auch die Bestimmung des BNP bzw.…”