Association of weaning failure from mechanical ventilation with transthoracic echocardiography parameters: a systematic review and meta-analysis

Abstract

Background: Weaning from mechanical ventilation is a challenging step during recovery from critical illness. Weaning failure or early reintubation are associated with increased morbidity and mortality, exposing patients to life-threatening complications. Cardiac dysfunction represents the most common cause of weaning failure. We conducted a systematic review and meta-analysis to evaluate the association between transthoracic echocardiographic parameters and weaning failure. Methods: We performed a systematic search of MEDLINE and EMBASE screening for prospective studies providing echocardiographic data collected just before the beginning of spontaneous breathing trial and outcome of the weaning attempt. We primarily focused on parameters currently recommended for evaluation of left ventricular (LV) systolic or diastolic dysfunction. Results: We included 11 studies in our primary analysis, which included data on LV ejection fraction (LVEF, n¼10 studies) and parameters recommended for the assessment of LV diastolic function (E/e 0 ratio n¼10; E/A ratio n¼9; E wave n¼8; and e 0 wave n¼7). Weaning failure was significantly associated to a higher E/e 0 ratio (standardised mean difference [SMD]¼ 1.70, 95% confidence interval [CI; 0.78e2.62]; P<0.001), lower e 0 wave (SMD¼À1.22, 95% CI [À2.33 to À0.11]; P¼0.03), and higher E wave (SMD¼0.97, 95% CI [0.29e1.65]; P¼0.005). We found no association between weaning failure and LVEF (SMD¼À0.86, 95% CI [À1.92e0.20]; P¼0.11) and E/A ratio (SMD¼0.00, 95% CI [À0.30e0.31]; P¼0.98). Conclusions: Weaning failure is associated with parameters indicating worse LV diastolic function (E/e 0 , e 0 wave, E wave) and increased LV filling pressure (E/e 0 ratio). The association between weaning failure and LV systolic dysfunction as evaluated by LVEF is more unclear. More studies are needed to clarify this aspect and regarding the role of right ventricular function.

Utility of the E/e′ index in ventilated patients and those with sepsis

“…We agree that the E/e′ index has some utility in predicting successful weaning from mechanical ventilation, as they have shown in their most recent meta‐analysis, 1 but published studies show high heterogeneity, there are often only small initial differences in mean E/e′ between patients who will remain off ventilation and those who will not, and average E/e′ values in both groups are sometimes within normal or intermediate ranges. Earlier systematic reviews also concluded that a higher E/e′ ratio is associated with weaning failure in ventilated patients 2 and that E/e′ (as well as other markers of diastolic dysfunction) predicts mortality in critically ill patients 3 .…”

Utility of the E/e’ index in ventilated patients and those with sepsis

“…We agree that the E/e' index has some utility in predicting successful weaning from mechanical ventilation, as they have shown in their most recent meta-analysis, 1 but published studies show high heterogeneity, there are often only small initial differences in mean E/e' between patients who will remain off ventilation and those who will not, and average E/e' values in both groups are sometimes within normal or intermediate ranges. Earlier systematic reviews also concluded that a higher E/e' ratio is associated with weaning failure in ventilated patients 2 and that E/e' (as well as other markers of diastolic dysfunction) predicts mortality in critically ill patients.…”

COVID-19-related echocardiographic patterns of cardiovascular dysfunction in critically ill patients: A systematic review of the current literature

“…For instance, 9 studies [ 17 , 22 , 24 , 30 , 32 , 34 , 41 , 42 , 44 ] reported a low mean troponin I level of 0.07 ± 0.09 ng/ml (Supplementary Materials raw data) which, once ruled out acute coronary ischemia, may be considered of multifactorial origin [ 50 ]. As part of routine bedside clinical assessment, echocardiography has gained popularity in ICU because of its wide availability, high diagnostic yield, and prognostic value [ [51] , [52] , [53] , [54] , [55] , [56] , [57] ].…”