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Echocardiography: a help in the weaning process

INTRODUCTION: To evaluate the ability of transthoracic echocardiography (TTE) to detect the effects of spontaneous breathing trial (SBT) on central hemodynamics and to identify indices predictive of cardiac-related weaning failure. METHODS: TTE was performed just before and at the end of a 30-min SB...

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Autores principales: Caille, Vincent, Amiel, Jean-Bernard, Charron, Cyril, Belliard, Guillaume, Vieillard-Baron, Antoine, Vignon, Philippe
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911768/
https://www.ncbi.nlm.nih.gov/pubmed/20569504
http://dx.doi.org/10.1186/cc9076
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author Caille, Vincent
Amiel, Jean-Bernard
Charron, Cyril
Belliard, Guillaume
Vieillard-Baron, Antoine
Vignon, Philippe
author_facet Caille, Vincent
Amiel, Jean-Bernard
Charron, Cyril
Belliard, Guillaume
Vieillard-Baron, Antoine
Vignon, Philippe
author_sort Caille, Vincent
collection PubMed
description INTRODUCTION: To evaluate the ability of transthoracic echocardiography (TTE) to detect the effects of spontaneous breathing trial (SBT) on central hemodynamics and to identify indices predictive of cardiac-related weaning failure. METHODS: TTE was performed just before and at the end of a 30-min SBT in 117 patients fulfilling weaning criteria. Maximal velocities of mitral E and A waves, deceleration time of E wave (DTE), maximal velocity of E' wave (tissue Doppler at the lateral mitral annulus), and left ventricular (LV) stroke volume were measured. Values of TTE parameters were compared between baseline (pressure support ventilation) and SBT in all patients and according to LV ejection fraction (EF): >50% (n = 58), 35% to 50% (n = 30), and <35% (n = 29). Baseline TTE indices were also compared between patients who were weaned (n = 94) and those who failed (n = 23). RESULTS: Weaning failure was of cardiac origin in 20/23 patients (87%). SBT resulted in a significant increase in cardiac output and E/A, and a shortened DTE. At baseline, DTE was significantly shorter in patients with LVEF <35% when compared to other subgroups (median [25(th)-75(th )percentiles]: 119 ms [90-153]; vs. 187 ms [144-224] vs. 174 ms [152-193]; P < 0.01) and E/E' was greater (7.9 [5.4-9.1] vs. 6.0 [5.3-9.0] vs. 5.2 [4.7-6.0]; P < 0.01). When compared to patients who were successfully weaned, those patients who failed exhibited at baseline a significantly lower LVEF (36% [27-55] vs. 51% [43-55]: P = 0.04) and higher E/E' (7.0 [5.0-9.2] vs. 5.6 [5.2-6.3]: P = 0.04). CONCLUSIONS: TTE detects SBT-induced changes in central hemodynamics. When performed by an experienced operator prior to SBT, TTE helps in identifying patients at high risk of cardiac-related weaning failure when documenting a depressed LVEF, shortened DTE and increased E/E'. Further studies are needed to evaluate the impact of this screening strategy on the weaning process and patient outcome.
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spelling pubmed-29117682010-07-29 Echocardiography: a help in the weaning process Caille, Vincent Amiel, Jean-Bernard Charron, Cyril Belliard, Guillaume Vieillard-Baron, Antoine Vignon, Philippe Crit Care Research INTRODUCTION: To evaluate the ability of transthoracic echocardiography (TTE) to detect the effects of spontaneous breathing trial (SBT) on central hemodynamics and to identify indices predictive of cardiac-related weaning failure. METHODS: TTE was performed just before and at the end of a 30-min SBT in 117 patients fulfilling weaning criteria. Maximal velocities of mitral E and A waves, deceleration time of E wave (DTE), maximal velocity of E' wave (tissue Doppler at the lateral mitral annulus), and left ventricular (LV) stroke volume were measured. Values of TTE parameters were compared between baseline (pressure support ventilation) and SBT in all patients and according to LV ejection fraction (EF): >50% (n = 58), 35% to 50% (n = 30), and <35% (n = 29). Baseline TTE indices were also compared between patients who were weaned (n = 94) and those who failed (n = 23). RESULTS: Weaning failure was of cardiac origin in 20/23 patients (87%). SBT resulted in a significant increase in cardiac output and E/A, and a shortened DTE. At baseline, DTE was significantly shorter in patients with LVEF <35% when compared to other subgroups (median [25(th)-75(th )percentiles]: 119 ms [90-153]; vs. 187 ms [144-224] vs. 174 ms [152-193]; P < 0.01) and E/E' was greater (7.9 [5.4-9.1] vs. 6.0 [5.3-9.0] vs. 5.2 [4.7-6.0]; P < 0.01). When compared to patients who were successfully weaned, those patients who failed exhibited at baseline a significantly lower LVEF (36% [27-55] vs. 51% [43-55]: P = 0.04) and higher E/E' (7.0 [5.0-9.2] vs. 5.6 [5.2-6.3]: P = 0.04). CONCLUSIONS: TTE detects SBT-induced changes in central hemodynamics. When performed by an experienced operator prior to SBT, TTE helps in identifying patients at high risk of cardiac-related weaning failure when documenting a depressed LVEF, shortened DTE and increased E/E'. Further studies are needed to evaluate the impact of this screening strategy on the weaning process and patient outcome. BioMed Central 2010 2010-06-22 /pmc/articles/PMC2911768/ /pubmed/20569504 http://dx.doi.org/10.1186/cc9076 Text en Copyright ©2010 Caille et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Caille, Vincent
Amiel, Jean-Bernard
Charron, Cyril
Belliard, Guillaume
Vieillard-Baron, Antoine
Vignon, Philippe
Echocardiography: a help in the weaning process
title Echocardiography: a help in the weaning process
title_full Echocardiography: a help in the weaning process
title_fullStr Echocardiography: a help in the weaning process
title_full_unstemmed Echocardiography: a help in the weaning process
title_short Echocardiography: a help in the weaning process
title_sort echocardiography: a help in the weaning process
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911768/
https://www.ncbi.nlm.nih.gov/pubmed/20569504
http://dx.doi.org/10.1186/cc9076
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