Diastolic Dysfunction is Predictive of Difficult Weaning from Cardiopulmonary Bypass

Bernard, Francis; Denault, André; Babin, Denis; Goyer, Caroline; Couture, Pierre; Couturier, A.; Buithieu, Jean

doi:10.1097/00000539-200102000-00002

Cited by 66 publications

(68 citation statements)

References 37 publications

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“…Factors, such as advanced age, female sex, time of extracorporeal circulation, cardiac dysfunction, and low cardiac output, may lead patients to long-term mechanical ventilation [5][6][7][8] . However, few reports exist about the conjunct use of parameters of respiratory system mechanics and oxygenation, and cardiovascular alterations as factors involved in the successful weaning of patients from long-term mechanical ventilation after cardiac surgery.…”

mentioning

confidence: 99%

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Nozawa¹,

Kobayashi²,

Matsumoto³

et al. 2003

Arq. Bras. Cardiol.

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OBJECTIVE: To analyze parameters of respiratory system mechanics and oxygenation and cardiovascular alterations involved in weaning tracheostomized patients from long-term mechanical ventilation after cardiac surgery. METHODS: We studied 45 patients in their postoperative period of cardiac surgery, who required long-term mechanical ventilation for more than 10 days and had to undergo tracheostomy due to unsuccessful weaning from mechanical ventilation. The parameters of respiratory system mechanics, oxigenation and the following factors were analyzed: type of surgical procedure, presence of cardiac dysfunction, time of extracorporeal circulation, and presence of neurologic lesions. RESULTS: Of the 45 patients studied, successful weaning from mechanical ventilation was achieved in 22 patients, while the procedure was unsuccessful in 23 patients. No statistically significant difference was observed between the groups in regard to static pulmonary compliance (p=0.23), airway resistance (p=0.21), and the dead space/tidal volume ratio (p=0.54). No difference was also observed in regard to the variables PaO2/FiO2 ratio (p=0.86), rapid and superficial respiration index (p=0.48), and carbon dioxide arterial pressure (p=0.86). Cardiac dysfunction and time of extracorporeal circulation showed a significant difference. CONCLUSION: Data on respiratory system mechanics and oxygenation were not parameters for assessing the success or failure. Cardiac dysfunction and time of cardiopulmonary bypass, however, significantly interfered with the success in weaning patients from mechanical ventilation

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mentioning

confidence: 99%

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Nozawa¹,

Kobayashi²,

Matsumoto³

et al. 2003

Arq. Bras. Cardiol.

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“…16 In this series, three of six patients with intraoperative diastolic dysfunction developed postoperative myocardial infarction, suggesting that the new onset of diastolic dysfunction may predict adverse outcome. It is unclear if the resolution of diastolic dysfunction associated with nitroglycerin infusion represents improved coronary blood flow or changes in ventricular loading conditions.…”

Section: Discussionmentioning

confidence: 74%

Acute diastolic dysfunction in thoracoabdominal aortic aneurysm surgery

Fayad

Yang

Nathan

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: To report transesophageal echocardiographic (TEE) findings consistent with intraoperative acute diastolic dysfunction in a series of patients undergoing thoracoabdominal aortic aneurysm (TAAA) repair.Methods: A series of nine consecutive patients underwent TAAA repair with intraoperative TEE monitoring. Surgical repair was performed with the adjunct of a left atrio-femoral bypass. Invasive arterial and venous pressures were monitored. Intraoperative TEE was utilized to assess the diastolic function before, and during aortic cross clamping. Diastolic dysfunction was defined as a mitral inflow pulsed wave Doppler (E: A ratio) < 1.Results: All patients demonstrated an E: A ratio > 1 (1.3 ± 0.08) before aortic cross clamping. During cross clamp, the E: A ratio decreased to < 1 (0.75 ± 0.05) in six of nine patients consistent with diastolic dysfunction. The three patients who did not develop E: A changes were receiving ß-blockers preoperatively. Patients with diastolic dysfunction were treated with nitroglycerin infusions, which resulted in restoration of their E: A ratios > 1 (1.2 ± 0.09). Three of the patients with intraoperative diastolic dysfunction developed postoperative myocardial infarction. Conclusions:Chronic diastolic dysfunction is a well-known entity. This report describes acute diastolic dysfunction, which was observed frequently in patients undergoing TAAA during aortic cross clamp. Further research is required to confirm this phenomenon and determine its possible association with increased postoperative cardiac morbidity. Objectif

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“…Our interobserver variability in the evaluation of cardiac function has been published. [6][7][8] A consensus had to be reached between the two TEE reviewers (A.D., P.C.) for an examination to be accepted as altering medical therapy, otherwise it was rejected.…”

Section: Methodsmentioning

confidence: 99%

Perioperative use of transesophageal echocardiography by anesthesiologists: Impact in noncardiac surgery and in the intensive care unit

Denault

Couture

McKenty

et al. 2002

Can J Anesth/J Can Anesth

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Background: The American Society of Anesthesiologists (ASA) has published practice guidelines for the use of perioperative transesophageal echocardiography (TEE) but the role and impact of TEE performed by anesthesiologists outside the cardiac operating room (OR) is still poorly explored. We report our experience in the use of TEE in the noncardiac OR, the recovery room and in the intensive care unit (ICU) in a university hospital, and analyze the impact of TEE on clinical decision making.Methods: Two hundred fourteen patients were included and TEE indications were classified prospectively according to the ASA guidelines. The examinations and data sheets were reviewed by two anesthesiologists with advanced training in TEE. For each examination, it was noted if TEE altered the management according to five groups: 1) changing medical therapy; 2) changing surgical therapy; 3) confirmation of a diagnosis; 4) positioning of an intravascular device; and 5) TEE used as a substitute to a pulmonary artery catheter.Results: Eighty-nine (37%), 67 (31%) and 58 (27%) patients had category I, II and III indications. The impact was more significant in category I where TEE altered therapy 60% of the time compared with 31% and 21% for categories II and III (P < 0.001). The most frequent reason for changing management was a modification in medical therapy in 53 instances (45%).Conclusion: Our results confirm a greater impact of TEE performed by anesthesiologists on clinical management for category I compared to category II and III indications in the noncardiac OR surgical setting and in the ICU.

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Diastolic Dysfunction is Predictive of Difficult Weaning from Cardiopulmonary Bypass

Cited by 66 publications

References 37 publications

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Acute diastolic dysfunction in thoracoabdominal aortic aneurysm surgery

Perioperative use of transesophageal echocardiography by anesthesiologists: Impact in noncardiac surgery and in the intensive care unit

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