Stress echocardiography in patients who experienced mechanical ventilation weaning failure

Ruiz-Bailén, Manuel; Cobo-Molinos, Jesús; Castillo-Rivera, Ana; Pola-Gallego-de-Guzmán, María Dolores; Cárdenas-Cruz, Antonio; Martínez‐Amat, Antonio; Sevilla-Martínez, María; Hernández-Caballero, Clara

doi:10.1016/j.jcrc.2017.01.004

Cited by 12 publications

(18 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results have been elegantly confirmed in a recent study using ephedrine stress echocardiography in patients without apparent LV systolic or diastolic dysfunction, but functional moderate-to-severe mitral regurgitation (28). Effective regurgitant volume and orifice area significantly increased as a result of raised LV afterload, reflecting the potential contribution of transiently worsened mitral regurgitation during the weaning process (28). Occult mitral regurgitation is frequently encountered in patients with coronary artery disease (31).…”

Section: Transthoracic Echocardiographymentioning

confidence: 77%

“…This suggests that the inability to improve relaxation during the adrenergic release at the time of SBT may represent an important factor contributing to weaning failure of cardiac origin (21). In keeping with these results, Ruiz-Bailén et al (28) recently showed that silent diastolic and systolic dysfunction could have a major impact on ventilator weaning in performing stress echocardiography in a population of cardiac patients who had been mechanically ventilated. In patients who failed weaning, dobutamine echocardiography disclosed an increased E/E' ratio and a deterioration of LV systolic performance (reduced strain and strain rate), when compared to those who were successfully weaned (28).…”

Section: Transthoracic Echocardiographymentioning

confidence: 83%

See 1 more Smart Citation

Cardiovascular failure and weaning

Vignon

2018

Ann. Transl. Med.

View full text Add to dashboard Cite

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.

show abstract

Section: Transthoracic Echocardiographymentioning

confidence: 77%

Section: Transthoracic Echocardiographymentioning

confidence: 83%

Cardiovascular failure and weaning

Vignon

2018

Ann. Transl. Med.

View full text Add to dashboard Cite

show abstract

“…As latent cardiac failure can become evident during stress, a stress echocardiography (using dobutamine to assess diastolic function as well as ephedrine to evaluate functional mitral regurgitation) was recently used to identify stress-related myocardial dysfunction during the weaning period in patients with resolved cardiogenic shock who experienced weaning failure [54]. It was proved helpful in detecting silent diastolic and systolic dysfunction or severe mitral regurgitation that could have a major impact on weaning outcome.…”

Section: Diagnostic Methods To Detect Cardiovascular Dysfunction In Pmentioning

confidence: 99%

Weaning failure of cardiovascular origin: how to suspect, detect and treat—a review of the literature

Routsi¹,

Stanopoulos²,

Kokkoris³

et al. 2019

Ann. Intensive Care

View full text Add to dashboard Cite

Among the multiple causes of weaning failure from mechanical ventilation, cardiovascular dysfunction is increasingly recognized as a quite frequent cause that can be treated successfully. In this review, we summarize the contemporary evidence of the most important clinical and diagnostic aspects of weaning failure of cardiovascular origin with special focus on treatment. Pathophysiological mechanisms are complex and mainly include increase in right and left ventricular preload and afterload and potentially induce myocardial ischemia. Patients at risk include those with preexisting cardiopulmonary disease either known or suspected. Clinically, cardiovascular etiology as a predominant cause or a contributor to weaning failure, though critical for early diagnosis and intervention, may be difficult to be recognized and distinguished from noncardiac causes suggesting the need of high suspicion. A cardiovascular diagnostic workup including bedside echocardiography, lung ultrasound, electrocardiogram and biomarkers of cardiovascular dysfunction or other adjunct techniques and, in selected cases, right heart catheterization and/or coronary angiography, should be obtained to confirm the diagnosis. Official clinical practice guidelines that address treatment of a confirmed weaning-induced cardiovascular dysfunction do not exist. As the etiologies of weaning-induced cardiovascular dysfunction are diverse, principles of management depend on the individual pathophysiological mechanisms, including preload optimization by fluid removal, guided by B-type natriuretic peptide measurement, nitrates administration in excessive afterload and/or myocardial ischemia, contractility improvement in severe systolic dysfunction as well as other rational treatment in specific indications in order to lead to successful weaning from mechanical ventilation.

show abstract

“…Several echocardiographic parameters can be used to predict ventilatory support weaning failure, especially those that allow the estimation of filling pressure and diastolic dysfunction. The influence of the systolic ejection fraction remains unclear, with contradictory results [ 13 , 18 , 19 , 20 ].…”

Section: Ultrasound Assessment In Mechanical Ventilation Weaningmentioning

confidence: 99%

“…When assessing diastolic function, obtaining an E/e’ mitral ratio higher than 14.5 is associated with higher rates of weaning failure, even in atrial fibrillation [ 13 , 19 , 20 ], as are E waves higher than 0.87 m/s [ 13 , 21 ] ( Figure 1 ). However, this method is less reliable in acute decompensated heart failure and left ventricles with larger volumes, where significant mitral regurgitation can lead to underestimation, as well as in resynchronization therapy and wide QRS and the subsequent change in septal e’ due to its abnormal motion [ 22 , 23 ].…”

Section: Ultrasound Assessment In Mechanical Ventilation Weaningmentioning

confidence: 99%

Ultrasound Assessment in Cardiogenic Shock Weaning: A Review of the State of the Art

Muñoz‐Rodríguez

García-González

Jorge-Pérez

et al. 2021

JCM

View full text Add to dashboard Cite

Cardiogenic shock (CS) is associated with a high in-hospital mortality despite the achieved advances in diagnosis and management. Invasive mechanical ventilation and circulatory support constitute the highest step in cardiogenic shock therapy. Once established, taking the decision of weaning from such support is challenging. Intensive care unit (ICU) bedside echocardiography provides noninvasive, immediate, and low-cost monitoring of hemodynamic parameters such as cardiac output, filling pressure, structural disease, congestion status, and device functioning. Supplemented by an ultrasound of the lung and diaphragm, it is able to provide valuable information about signs suggesting a weaning failure. The aim of this article was to review the state of the art taking into account current evidence and knowledge on ICU bedside ultrasound for the evaluation of weaning from mechanical ventilation and circulatory support in cardiogenic shock.

show abstract

Stress echocardiography in patients who experienced mechanical ventilation weaning failure

Cited by 12 publications

References 23 publications

Cardiovascular failure and weaning

Cardiovascular failure and weaning

Weaning failure of cardiovascular origin: how to suspect, detect and treat—a review of the literature

Ultrasound Assessment in Cardiogenic Shock Weaning: A Review of the State of the Art

Contact Info

Product

Resources

About