Diastolic dysfunction as a predictor of weaning failure: A systematic review and meta-analysis

Almeida, Carla; Nedel, Wagner Luís; Morais, Vinícius Daudt; Boniatti, Márcio Manozzo; Almeida-Filho, O.C. de

doi:10.1016/j.jcrc.2016.03.007

Cited by 41 publications

(28 citation statements)

References 29 publications

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“…Accordingly, the same diagnostic approach applies for WiPO resulting in a failed SBT or in a failed extubation. Not surprisingly, patients with LV diastolic failure-especially of high grade-have a higher rate of SBT failure than patients with normal relaxation (18). Most of echocardiographic studies have emphasized the important role of LV diastolic dysfunction rather than LV systolic failure during unsuccessful weaning (15).…”

Section: Transthoracic Echocardiographymentioning

confidence: 99%

Cardiovascular failure and weaning

Vignon

2018

Ann. Transl. Med.

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Cardiac patients are at high risk of weaning failure due to the abrupt burden to the cardiovascular system resulting from the transition from positive-pressure ventilation to spontaneous breathing. Similarly, numerous patients with borderline cardiac function, left ventricular diastolic dysfunction, chronic obstructive pulmonary disease, especially with associated fluid overload or cumulative positive fluid balance, are at high risk of weaning failure of cardiac origin. The diagnosis of weaning-induced pulmonary oedema (WiPO) relies on the measurement of elevated left ventricular filling pressure, or on the presence of a surrogate reflecting pulmonary or cardiac congestion. Plasma concentration of B-type natriuretic peptide and N-terminal proBNP, biological signs of hemoconcentration (increased circulating protein or hemoglobin levels), or measurement of extravascular pulmonary lung water using transpulmonary thermodilution have been proved valuable surrogates for the identification of weaning failure. Nevertheless, studies have not yet compared these indirect methods to precisely determine their respective diagnostic values for the identification of WiPO, especially in heart failure patients. In addition, none of these approaches directly assess left ventricular filling pressure and the mechanism of WiPO. In contrast, critical care echocardiography is ideally suited to establish the diagnosis of weaning failure of cardiac origin. It allows identifying the high-risk population, monitoring hemodynamically the patient at risk, depicting an abrupt increase of left ventricular filling pressure consistent with WiPO when the patient fails weaning, identifying the underlying mechanism of WiPO, and finally it allows tailoring the therapeutic management of the patient who failed weaning. The impact on patient-centered outcomes of such integrated management strategy based on critical care echocardiography deserves to be prospectively tested in a large population of patients at high risk of weaning failure of cardiac origin.

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Section: Transthoracic Echocardiographymentioning

confidence: 99%

Cardiovascular failure and weaning

Vignon

2018

Ann. Transl. Med.

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“…Septal and lateral mitral annular e’ values are usually averaged for the E/e’ ratio. The E/e’ ratio, pulmonary venous flow and E wave deceleration time assessment could each be incrementally useful parameters to assess left atrial pressure [ 29 ]. Reference values in the critically ill have not been validated for many echocardiography parameters in the critically ill, especially left atrial pressure.…”

Section: Left Atrial Pressure Vs Diastolic Dysfunction: What Does It mentioning

confidence: 99%

Pearls and pitfalls in comprehensive critical care echocardiography

et al. 2017

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Critical care echocardiography is developing rapidly with an increasing number of specialists now performing comprehensive studies using Doppler and other advanced techniques. However, this imaging can be challenging, interpretation is far from simple in the complex critically ill patient and mistakes can be easy to make. We aim to address clinically relevant areas where potential errors may occur and suggest methods to hopefully improve accuracy of imaging and interpretation.

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“…Daily assessment for readiness-to-wean had been a routine recommendation for every mechanically ventilated patient [23]; however, this approach might be associated with premature extubation leading to weaning failure; thus, meticulous research is continuously conducted for reaching accurate parameters for predicting weaning failure. Various parameters had been previously reported as predictors of lung congestion-related weaning failure such as pulmonary artery occlusion pressure which requires the presence of pulmonary artery catheter [14], impaired left ventricular systolic function [8], and impaired left ventricular diastolic function [24,25]; both are assessed using echocardiography. Brain natriuretic peptide was reported as another predictor for weaning outcome [7].…”

Section: Discussionmentioning

confidence: 99%

Thoracic fluid content: a novel parameter for predicting failed weaning from mechanical ventilation

et al. 2020

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Background: Weaning of patients from the mechanical ventilation remains one of the critical decisions in intensive care unit. This study aimed to evaluate the accuracy of thoracic fluid content (TFC) as a predictor of weaning outcome.Methods: An observational cohort study included 64 critically ill surgical patients who were eligible for extubation. Before initiating the spontaneous breathing trial, the TFC was measured using the electrical cardiometry technology. Patients were followed up after extubation and divided into successful weaning group and failed weaning group. Both groups were compared according to respiratory and cardiovascular parameters. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of TFC to predict weaning outcome. Results: The number of successfully weaned patients was 41/64 (64%). Twenty (31%) patients had impaired cardiac contractility, and of them, 13/20 (64%) patients were successfully extubated. Both groups, successful weaning group and failed weaning group, were comparable in most of baseline characteristics; however, the TFC was significantly higher in the failed weaning group compared to the successful weaning group. The area under the ROC curves (AUCs) showed moderate predictive ability for the TFC in predicting weaning failure (AUC [95% confidence interval] 0.69 [0.57-0.8], cutoff value > 50 kΩ −1 ), while the predictive ability of TFC was excellent in the subgroup of patients with ejection fraction < 40% (AUC [95% confidence interval 0.93 [0.72-1], cutoff value > 50 kΩ −1 ). Conclusions: Thoracic fluid content showed moderate ability for predicting weaning outcome in surgical critically ill patients. However, in the subgroup of patients with ejection fraction less than 40%, TFC above 50 kΩ −1 has an excellent ability to predict weaning failure.

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Diastolic dysfunction as a predictor of weaning failure: A systematic review and meta-analysis

Cited by 41 publications

References 29 publications

Cardiovascular failure and weaning

Cardiovascular failure and weaning

Pearls and pitfalls in comprehensive critical care echocardiography

Thoracic fluid content: a novel parameter for predicting failed weaning from mechanical ventilation

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