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Intensive Care Medicine

, Volume 37, Issue 12, pp 1976–1985 | Cite as

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

  • John PapanikolaouEmail author
  • Demosthenes Makris
  • Theodosios Saranteas
  • Dimitrios Karakitsos
  • Elias Zintzaras
  • Andreas Karabinis
  • Georgia Kostopanagiotou
  • Epaminondas ZakynthinosEmail author
Original

Abstract

Purpose

To investigate the diagnostic performance of Doppler echocardiography (DE) in predicting the outcome of weaning from mechanical ventilation in patients without overt cardiac disease.

Methods

Fifty critical care noncardiac patients who fulfilled predetermined criteria for weaning underwent DE before and at the end of spontaneous breathing trial (pre-SBT/end-SBT, respectively). “Conventional” mitral inflow analysis and “advanced” DE parameters [tissue Doppler imaging (TDI)-derived mitral/tricuspid annular velocities and color M-mode Doppler velocity of propagation (V p)] were used to assess left ventricular (LV) diastolic function/filling pressures. Weaning was considered successful if patients had been extubated after successful SBT and sustained spontaneous breathing for more than 48 h.

Results

Twenty-eight patients (56%) failed weaning: 23 patients failed SBT and 5 required reintubation within 48 h. Weaning failure was associated with the degree of LV diastolic dysfunction at pre-SBT (P = 0.01). Patients who failed weaning presented evidence of increased LV filling pressures at pre-SBT, by demonstrating increased E/E m and E/V p ratios compared with patients with successful outcome (P ≤ 0.004); pre-SBT values of lateral E/E m greater than 7.8 and E/V p greater than 1.51 predicted weaning failure with an area under the curve, sensitivity (%), and specificity (%) of 0.86, 79, and 100, and 0.74, 75, and 73, respectively. Lateral E/E m was the only factor independently associated with weaning failure before SBT; OR (95% CI) 5.62 (1.17–26.96), P = 0.03.

Conclusions

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.

Keywords

Doppler echocardiography Left ventricular diastolic dysfunction Spontaneous breathing trial Weaning outcome 

Notes

Acknowledgments

J. P. drafted the manuscript and participated in the collection of data; D. M. drafted part of the manuscript and revised the manuscript for important intellectual content; T. S., D. K., and A. K. participated in the collection of data; El. Z. performed statistical analysis; E. Z. performed off-line echocardiographic analysis; E. Z. and G. K. contributed equally in the study design and motivated the study.

Supplementary material

134_2011_2368_MOESM1_ESM.doc (631 kb)
Online Data Supplement (DOC 631 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • John Papanikolaou
    • 1
    • 6
    Email author
  • Demosthenes Makris
    • 1
  • Theodosios Saranteas
    • 2
  • Dimitrios Karakitsos
    • 3
  • Elias Zintzaras
    • 4
    • 5
  • Andreas Karabinis
    • 3
  • Georgia Kostopanagiotou
    • 2
  • Epaminondas Zakynthinos
    • 1
    • 6
    Email author
  1. 1.Department of Critical Care, School of MedicineUniversity of Thessaly, University Hospital of LarissaThessalyGreece
  2. 2.2nd Department of Anaesthesiology, School of MedicineUniversity of Athens, University Hospital of Athens ‘Attikon’AthensGreece
  3. 3.Department of Critical CareGeneral State Hospital of AthensAthensGreece
  4. 4.Department of Biomathematics, School of MedicineUniversity of ThessalyLarissaGreece
  5. 5.Institute for Clinical Research and Health Policy Studies, Tufts Medical CenterTufts University School of MedicineBostonUSA
  6. 6.BiopolisLarissaGreece

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