Abstract

BackgroundLiberation from the ventilator is a difficult task, whereas early echocardiographic indices of weaning readiness are still lacking. The aim of this study was to test whether tricuspid annular plane systolic excursion (TAPSE) and right ventricular (RV) systolic (Sm) and diastolic (Em & Am) tissue Doppler imaging (TDI) velocities are related with duration of weaning in mechanically ventilated patients with acute respiratory failure due to acute pulmonary edema (APE).MethodsDetailed quantification of left and right ventricular systolic and diastolic function was performed at admission to the Intensive Care Unit by Doppler echocardiography, in a cohort of 32 mechanically ventilated patients with APE. TAPSE and RV TDI velocities were compared between patients with and without prolonged weaning (≥ or < 7 days from the first weaning trial respectively), whereas their association with duration of ventilation and left ventricular (LV) echo-derived indices was tested with multivariate linear and logistic regression analysis.ResultsPatients with prolonged weaning (n = 12) had decreased TAPSE (14.59 ± 1.56 vs 19.13 ± 2.59 mm), Sm (8.68 ± 0.94 vs 11.62 ± 1.77 cm/sec) and Em/Am ratio (0.98 ± 0.80 vs 2.62 ± 0.67, p <0.001 for all comparisons) and increased Ε/e' (11.31 ± 1.02 vs 8.98 ± 1.70, p <0.001) compared with subjects without prolonged weaning (n = 20). Logistic regression analysis revealed that TAPSE (R2 = 0.53, beta slope = 0.76, p < 0.001), Sm (R2 = 0.52, beta = 0.75, p < 0.001) and Em/Am (R2 = 0.57, beta = 0.32, p < 0.001) can predict length of weaning ≥ 7 days. The above measures were also proven to correlate significantly with Ε/e' (r = -0.83 for TAPSE, r = -0.87 for Sm and r = -0.79 for Em/Am, p < 0.001 for all comparisons).ConclusionsWe suggest that in mechanically ventilated patients with APE, low TAPSE and RV TDI velocities upon admission are associated with delayed liberation from mechanical ventilation, probably due to more severe LV heart failure.

Highlights

  • Liberation from the ventilator is a difficult task, whereas early echocardiographic indices of weaning readiness are still lacking

  • Half of the patients (n = 16, 50%) presented with pulmonary edema due to acute decompensation of chronic heart failure (CHF), that was attributed to lower respiratory track infection in 12 cases and unspecified reasons in the rest 4

  • Logistic regression analysis revealed that tricuspid annular plane systolic excursion (TAPSE) (R2 = 0.53, multiple R = 0.73, beta = 0.76 with beta standard error (SE) = 0.043, p < 0.001), Left ventricular ejection fraction (LVEF) (R2 = 0.43, multiple R = 0.66, beta = 0.87 with beta SE = 0.03, p < 0.001), Sm (R2 = 0.52, multiple R = 0.72, beta = 0.75 with beta SE = 0.03, p < 0.001), Em/ Am (R2 = 0.57, multiple R = 0.75, beta = 0.32 with beta SE = 0.05, p < 0.001) and Right ventricular fractional area change (RVFAC) (R2 = 0.52 multiple R = 0.72, beta slope = 0.74 with beta SE = 0.03, p < 0.001) can predict length of weaning ≥ 7 days

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Summary

Introduction

Liberation from the ventilator is a difficult task, whereas early echocardiographic indices of weaning readiness are still lacking. The aim of this study was to test whether tricuspid annular plane systolic excursion (TAPSE) and right ventricular (RV) systolic (Sm) and diastolic (Em & Am) tissue Doppler imaging (TDI) velocities are related with duration of weaning in mechanically ventilated patients with acute respiratory failure due to acute pulmonary edema (APE). We decided to correlate these measures with different echocardiographic indices of LV function, in order to estimate their accuracy in discriminating patients with more or less severe LV heart failure In this case, changes of the right side of the heart could reliably reflect left sided findings, early in the course of liberating patients from the ventilator and identify a unique value of such analysis

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