C A de Meirelles Almeida1, W L Nedel2, V D Morais2, M M Boniatti3, O C de Almeida-Filho4. 1. Intensive Care Unit, Hospital Montenegro, Montenegro, Brazil. Electronic address: cesarmeirelles2004@yahoo.com.br. 2. Intensive Care Unit, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil. 3. Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. 4. Doppler Echocardiography Laboratory, Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, Brazil.
Abstract
PURPOSE: Weaning failure and prolonged mechanical ventilation are associated with increased morbidity, cost of care, and high mortality rates. In the last few years, cardiac performance has been recognized as a common etiology of weaning failure, and growing evidence suggests that left ventricular diastolic dysfunction is a key factor that determines weaning outcomes. Therefore, we performed a systematic review and a meta-analysis to evaluate whether diastolic dysfunction in the critically ill patient subjected to mechanical ventilation is an independent predictor of weaning failure. MATERIALS AND METHODS: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, Google Scholar, and ClinicalTrials.gov from inception to September 2014, along with conferences proceeding from January 2005 through September 2014, and included Observational Studies and Randomized Clinical Trials evaluating predictors of weaning failure. RESULTS: Ten studies were included in the systematic review; and 7, in the meta-analysis (6 observational studies and 1 randomized controlled trial). Patients who developed weaning failure had a higher E/e' ratio when compared with those who did not (mean difference, 2.65; 95% confidence interval, 0.52-4.79; P= .01); however, there was no difference in the E/A ratio (mean difference, 0.07; 95% confidence interval, -0.04 to 0.18; P= .22). Both the E/e' and E/A ratios were associated with weaning-induced pulmonary edema at the end of a spontaneous breathing trial. CONCLUSION: A higher E/e' ratio is significantly associated with weaning failure, although a high heterogeneity of diastolic dysfunction criteria and different clinical scenarios limit additional conclusions linking diastolic dysfunction with weaning failure.
PURPOSE:Weaning failure and prolonged mechanical ventilation are associated with increased morbidity, cost of care, and high mortality rates. In the last few years, cardiac performance has been recognized as a common etiology of weaning failure, and growing evidence suggests that left ventricular diastolic dysfunction is a key factor that determines weaning outcomes. Therefore, we performed a systematic review and a meta-analysis to evaluate whether diastolic dysfunction in the critically ill patient subjected to mechanical ventilation is an independent predictor of weaning failure. MATERIALS AND METHODS: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, Google Scholar, and ClinicalTrials.gov from inception to September 2014, along with conferences proceeding from January 2005 through September 2014, and included Observational Studies and Randomized Clinical Trials evaluating predictors of weaning failure. RESULTS: Ten studies were included in the systematic review; and 7, in the meta-analysis (6 observational studies and 1 randomized controlled trial). Patients who developed weaning failure had a higher E/e' ratio when compared with those who did not (mean difference, 2.65; 95% confidence interval, 0.52-4.79; P= .01); however, there was no difference in the E/A ratio (mean difference, 0.07; 95% confidence interval, -0.04 to 0.18; P= .22). Both the E/e' and E/A ratios were associated with weaning-induced pulmonary edema at the end of a spontaneous breathing trial. CONCLUSION: A higher E/e' ratio is significantly associated with weaning failure, although a high heterogeneity of diastolic dysfunction criteria and different clinical scenarios limit additional conclusions linking diastolic dysfunction with weaning failure.
Authors: Alexis Ferré; Max Guillot; Daniel Lichtenstein; Gilbert Mezière; Christian Richard; Jean-Louis Teboul; Xavier Monnet Journal: Intensive Care Med Date: 2019-03-12 Impact factor: 17.440
Authors: Shymaa Fathy; Ahmed M Hasanin; Mohamed Raafat; Maha M A Mostafa; Ahmed M Fetouh; Mohamed Elsayed; Esraa M Badr; Hanan M Kamal; Ahmed Z Fouad Journal: J Intensive Care Date: 2020-03-05