New insights into weaning from mechanical ventilation: left ventricular diastolic dysfunction is a key player

Abstract

Our findings suggest that LV diastolic dysfunction is significantly associated with weaning outcome in critically ill patients with preserved LV systolic function. An E/E m ratio greater than 7.8 may identify patients at high risk of weaning failure.

Noninvasive Monitoring of Cardiac Output During Weaning From Mechanical Ventilation: A Pilot Study

“…Among these conditions are myocardial ischemia and congestive heart failure. 1 The decrease in ventilator support during a spontaneous breathing trial (SBT) can increase preload, afterload, and catecholamine release [2][3][4][5] and possibly exacerbate underlying cardiac dysfunction, resulting in pulmonary edema and unsuccessful weaning. These processes may also cause myocardial ischemia, 6 leading to pulmonary edema related to the increased transmural pulmonary artery occlusion pressure associated with decreased myocardial compliance.…”

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

“…The result indicated that LV diastolic dysfunction is significantly associated with weaning outcome in critically ill patients with preserved LV systolic function. An E/E a ratio greater than 7.8 may identify patients at high risk of weaning failure [17]. Schifelbain et al conducted randomized crossover clinical trial of 24 patients to analyze changes in cardiac function, using Doppler echocardiogram, in critical patients during weaning from MV.…”

On the role of left ventricular diastolic function in the critically ill patient

“…The main result is presented in Fig. 2 of their study [1]. Among the 23 patients without LV diastolic dysfunction before the spontaneous breathing trial (SBT), eight failed to be weaned (35%), whereas among the 20 patients with moderate to severe LV diastolic dysfunction, 80% failed to be weaned.…”

“…In the December 2011 issue of Intensive Care Medicine, Papanikolaou and coworkers [1] reported their investigation into the diagnostic performance of echocardiography in predicting the outcome of weaning, and especially the role of left ventricular (LV) diastolic function in weaning failure. The main result is presented in Fig.…”

“…In patients with mild diastolic dysfunction, 3/7 (57%) failed. Overall, cardiogenic pulmonary edema was suspected to be the cause of weaning failing in 65% of cases [1]. The originality of the study, which renders it especially interesting, is that Papanikolaou and coworkers only included patients with preserved LV systolic function.…”