Hemodynamic changes during weaning: can we assess and predict cardiac-related weaning failure by transthoracic echocardiography?

Gorazd Voga

doi:10.1186/cc9085

Abstract

Cardiac-related failure of weaning from mechanical ventilation is an important reason for prolonged mechanical ventilation, intensive care unit treatment, and increased morbidity and mortality. When transthoracic echocardiography (TTE) is routinely performed before a weaning trial, patients at high risk of cardiac-related failure can be detected by low left ventricular (LV) ejection fraction, diastolic dysfunction, and elevated LV filling pressure. During the weaning trial, a further increase of LV filling pressure and progression of diastolic failure can be observed by repeated TTE. Owing to certain limitations concerning patients and methodology, TTE cannot be employed in every patient and invasive hemodynamic monitoring is still mandatory in selected patients with repetitive weaning failure.

Highlights

Cardiac-related failure of weaning from mechanical ventilation is an important reason for prolonged mechanical ventilation, intensive care unit treatment, and increased morbidity and mortality
In the previous issue of Critical Care, Caille and colleagues [1] evaluated the ability of transthoracic echocardiography (TTE) to predict cardiac-related weaning failure and to assess the hemodynamic changes before and 30 minutes after the start of a spontaneous breathing trial (SBT)
*Correspondence: gorazd.voga@guest.arnes.si Medical Intensive Care Unit, General Hospital Celje, Oblakova 5, 3000. If these results are translated into simple clinical language, patients with weaning failure were tachycardic and had depressed systolic function and diastolic dysfunction with elevated left ventricular (LV) filling pressure before SBT

Summary

Introduction

Cardiac-related failure of weaning from mechanical ventilation is an important reason for prolonged mechanical ventilation, intensive care unit treatment, and increased morbidity and mortality. In the previous issue of Critical Care, Caille and colleagues [1] evaluated the ability of transthoracic echocardiography (TTE) to predict cardiac-related weaning failure and to assess the hemodynamic changes before and 30 minutes after the start of a spontaneous breathing trial (SBT). Weaning failed in 23 of 117 patients, and failure was of cardiac origin in the majority (20 of 23) of them.

Results

Conclusion