Advertisement

Intensive Care Medicine

, Volume 31, Issue 12, pp 1634–1642 | Cite as

Differential cardiovascular responses during weaning failure: effects on tissue oxygenation and lactate

  • Spyros ZakynthinosEmail author
  • Christina Routsi
  • Theodoros Vassilakopoulos
  • Panagiotis Kaltsas
  • Epaminondas Zakynthinos
  • Danai Kazi
  • Charis Roussos
Original

Abstract

Objective

To test the following two hypotheses during weaning failure: (a) mixed venous oxygen saturation (SvO2) does not decrease in patients whose oxygen consumption does not increase, and (b) blood lactate may increase in patients who demonstrate substantial decreases in SvO2.

Design and setting

A prospective observational and physiological study in a 30-bed university intensive care unit.

Patients and participants

18 patients who failed weaning and 12 patients who succeeded weaning (controls).

Measurements and results

Hemodynamics, global tissue oxygenation, cardiovascular response (cardiac index/oxygen extraction diagram), and blood lactate were measured in ventilator-supported patients undergoing a spontaneous breathing trial. In patients who failed without having increased their oxygen consumption (n=9) the increase in oxygen delivery was accompanied by a decrease in oxygen extraction (by 15±4%). In patients who failed (n=9) having increased their oxygen consumption (by >10%) this increase was met mainly by an increase in oxygen extraction (by 30±7%). SvO2 increased by 2±1% in the former patients, whereas it decreased by 20±5% in the latter. Arterial lactate increased (range 2.3–3.1 mM/l) in only three patients who failed to have increased oxygen consumption and exhibited heart failure and the highest decreases in SvO2 (by 12–39%).

Conclusions

Patients whose SvO2 does not decrease during weaning failure do not have increased oxygen consumption probably due to respiratory center depression in some of them. Patients whose SvO2 decreases have increased oxygen consumption.

Keywords

Ventilation Hemodynamics Heart failure Cardiac output Mechanical ventilation 

Notes

Conflict of interest:

No information supplied

Supplementary material

supp.pdf (285 kb)
(PDF 286 KB)

References

  1. 1.
    Vassilakopoulos T, Zakynthinos S, Roussos C (1996) Respiratory muscles and weaning failure. Eur Respir J 9:2383–2400CrossRefPubMedGoogle Scholar
  2. 2.
    Jubran A, Mathru M, Dries D, Tobin M (1998) Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof. Am J Respir Crit Care Med 158:1763–1769PubMedGoogle Scholar
  3. 3.
    Pinsky MR (2000) Breathing as exercise: the cardiovascular response to weaning from mechanical ventilation. Intensive Care Med 26:1164–1166CrossRefPubMedGoogle Scholar
  4. 4.
    Sutton JR, Reeves JT, Wagner PD, Groves BM, Cymerman A, Malconian MK, Rock PB, Young PM, Walter SD, Houston CS (1988) Operation Everest II: oxygen transport during exercise at extreme simulated altitude. J Appl Physiol 64:1309–1321PubMedGoogle Scholar
  5. 5.
    Weber KT, Janicki JS, McElroy PA, Reddy HK (1988) Concepts and applications of cardiopulmonary exercise testing. Chest 93:843–847PubMedGoogle Scholar
  6. 6.
    Herrlin B, Sylven C (1991) Increased arterial oxygen content-an important compensatory mechanism in chronic moderate heart failure. Cardiovasc Res 25:384–390PubMedGoogle Scholar
  7. 7.
    Magder S, Erian R, Roussos C (1986) Respiratory muscle blood flow in oleic acid-induced pulmonary edema. J Appl Physiol 6:1849–1856Google Scholar
  8. 8.
    Viires N, Sillye G, Aubier M, Rassidakis A, Roussos C (1983) Regional blood flow distribution in dogs during induced hypotention and low cardiac output: spontaneous breathing versus artificial ventilation. J Clin Invest 72:935–947PubMedGoogle Scholar
  9. 9.
    Gil A, Carrizosa F, Herrero A, Martin J, Gonzalez J, Jareno A, Rivero J (1998) Influence of mechanical ventilation on blood lactate in patients with acute respiratory failure. Intensive Care Med 24:924–930CrossRefPubMedGoogle Scholar
  10. 10.
    Mohsenifar Z, Hay A, Hay J, Lewis MI, Koerner SK (1993) Gastric intramural pH as a predictor of success or failure in weaning patients from mechanical ventilation. Ann Intern Med 119:794–798PubMedGoogle Scholar
  11. 11.
    Bouachour G, Guiraud MP, Gouello JP, Roy PM, Alquier P (1996) Gastric intramucosal pH: an indicator of weaning outcome from mechanical ventilation in COPD patients. Eur Respir J 9:1868–1873CrossRefPubMedGoogle Scholar
  12. 12.
    Routsi C, Zakynthinos S, Kaltsas P, Metafa M, Kazi D, Gonis A, Sotiropoulou C, Roussos C (1999) Lactate elevation during weaning trials from mechanical ventilation (abstract). Am J Respir Crit Care Med 159:A371Google Scholar
  13. 13.
    Mizock BA, Falk JL (1992) Lactic acidosis in critical illness. Crit Care Med 20:80–93PubMedGoogle Scholar
  14. 14.
    Jubran A, Tobin M (1997) Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. Am J Respir Crit Care Med 155:906–915PubMedGoogle Scholar
  15. 15.
    Esteban Α, Frutos F, Tobin ΜJ, Alia I, Solsona JF, Valverdu I, Fernandez R, De La Cal A, Benito S, Tomas R, Carriedo D, Macias S, Blanco J (1995) Α comparison of four methods of weaning patients from mechanical ventilation. Ν Engl J Med 332:345–350Google Scholar
  16. 16.
    Yang KL, Tobin MJ (1991) A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. Ν Engl J Med 324:1445–1450Google Scholar
  17. 17.
    Silance P-G, Simon C, Vincent JL (1994) The relation between cardiac index and oxygen extraction in acutely ill patients. Chest 105:1190–1197PubMedGoogle Scholar
  18. 18.
    De Backer D, Moraine JJ, Berre J, Kahn RJ, Vincent JL (1994) Effects of dobutamine on oxygen consumption in septic patients: direct vs indirect determinations. Am J Respir Crit Care Med 150:95–100PubMedGoogle Scholar
  19. 19.
    De Backer D, El Haddad P, Preiser JC, Vincent JL (2000) Hemodynamic responses to successful weaning from mechanical ventilation after cardiovascular surgery. Intensive Care Med 26:1201–1206CrossRefPubMedGoogle Scholar
  20. 20.
    Yalavatti GS, De Backer D, Vincent JL (2000) Assessment of cardiac index in anemic patients. Chest 118:782–787CrossRefPubMedGoogle Scholar
  21. 21.
    Field S, Kelly SM, Macklem ΡΤ (1982) The oxygen cost of breathing in patients with cardiorespiratory disease. Am Rev Respir Dis 126:9–13PubMedGoogle Scholar
  22. 22.
    Brochard L, Hart Α, Lorino Η, Lemaire F (1989) Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. Am Rev Respir Dis 139:513–521PubMedGoogle Scholar
  23. 23.
    Berry PR, Pontoppidan H (1968) Oxygen consumption and blood gas exchange during controlled and spontaneous ventilation in patients with respiratory failure. Anesthesiology 29:177–178Google Scholar
  24. 24.
    Marini JJ (1986) The physiologic determinants of ventilator dependence. Respir Care 31:271–282Google Scholar
  25. 25.
    Mas A, Saura P, Joseph D, Blanch L, Baigorri F, Artigas A, Fernandez R (2000) Effects of acute moderate changes in PaCO2 on global hemodynamics and gastric perfusion. Crit Care Med 28:360–365CrossRefPubMedGoogle Scholar
  26. 26.
    Feihl F, Perret C (1994) Permissive hypercapnia: how permissive should we be? Am J Respir Crit Care Med 150:1722–1737PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Spyros Zakynthinos
    • 1
    Email author
  • Christina Routsi
    • 1
  • Theodoros Vassilakopoulos
    • 1
  • Panagiotis Kaltsas
    • 1
  • Epaminondas Zakynthinos
    • 1
  • Danai Kazi
    • 1
  • Charis Roussos
    • 1
  1. 1.Department of Critical Care and Pulmonary ServicesUniversity of Athens Medical School, Evangelismos HospitalAthensGreece

Personalised recommendations