Association of weaning failure from mechanical ventilation with transthoracic echocardiography parameters: a systematic review and meta-analysis.

Echocardiography / methods Heart Diseases / diagnosis Humans Respiration, Artificial Ventilator Weaning
T-tube critical care echocardiography extubation mechanical ventilation reintubation spontaneous breathing trial weaning

Journal

British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541

Informations de publication

Date de publication:
Jan 2021
Historique:
received: 01 05 2020
revised: 26 06 2020
accepted: 26 07 2020
pubmed: 30 9 2020
medline: 29 1 2021
entrez: 29 9 2020
Statut: ppublish

Résumé

Weaning from mechanical ventilation is a challenging step during recovery from critical illness. Weaning failure or early reintubation are associated with increased morbidity and mortality, exposing patients to life-threatening complications. Cardiac dysfunction represents the most common cause of weaning failure. We conducted a systematic review and meta-analysis to evaluate the association between transthoracic echocardiographic parameters and weaning failure. We performed a systematic search of MEDLINE and EMBASE screening for prospective studies providing echocardiographic data collected just before the beginning of spontaneous breathing trial and outcome of the weaning attempt. We primarily focused on parameters currently recommended for evaluation of left ventricular (LV) systolic or diastolic dysfunction. We included 11 studies in our primary analysis, which included data on LV ejection fraction (LVEF, n=10 studies) and parameters recommended for the assessment of LV diastolic function (E/e' ratio n=10; E/A ratio n=9; E wave n=8; and e' wave n=7). Weaning failure was significantly associated to a higher E/e' ratio (standardised mean difference [SMD]=1.70, 95% confidence interval [CI; 0.78-2.62]; P<0.001), lower e' wave (SMD=-1.22, 95% CI [-2.33 to -0.11]; P=0.03), and higher E wave (SMD=0.97, 95% CI [0.29-1.65]; P=0.005). We found no association between weaning failure and LVEF (SMD=-0.86, 95% CI [-1.92-0.20]; P=0.11) and E/A ratio (SMD=0.00, 95% CI [-0.30-0.31]; P=0.98). Weaning failure is associated with parameters indicating worse LV diastolic function (E/e', e' wave, E wave) and increased LV filling pressure (E/e' ratio). The association between weaning failure and LV systolic dysfunction as evaluated by LVEF is more unclear. More studies are needed to clarify this aspect and regarding the role of right ventricular function.

Sections du résumé

BACKGROUND BACKGROUND
Weaning from mechanical ventilation is a challenging step during recovery from critical illness. Weaning failure or early reintubation are associated with increased morbidity and mortality, exposing patients to life-threatening complications. Cardiac dysfunction represents the most common cause of weaning failure. We conducted a systematic review and meta-analysis to evaluate the association between transthoracic echocardiographic parameters and weaning failure.
METHODS METHODS
We performed a systematic search of MEDLINE and EMBASE screening for prospective studies providing echocardiographic data collected just before the beginning of spontaneous breathing trial and outcome of the weaning attempt. We primarily focused on parameters currently recommended for evaluation of left ventricular (LV) systolic or diastolic dysfunction.
RESULTS RESULTS
We included 11 studies in our primary analysis, which included data on LV ejection fraction (LVEF, n=10 studies) and parameters recommended for the assessment of LV diastolic function (E/e' ratio n=10; E/A ratio n=9; E wave n=8; and e' wave n=7). Weaning failure was significantly associated to a higher E/e' ratio (standardised mean difference [SMD]=1.70, 95% confidence interval [CI; 0.78-2.62]; P<0.001), lower e' wave (SMD=-1.22, 95% CI [-2.33 to -0.11]; P=0.03), and higher E wave (SMD=0.97, 95% CI [0.29-1.65]; P=0.005). We found no association between weaning failure and LVEF (SMD=-0.86, 95% CI [-1.92-0.20]; P=0.11) and E/A ratio (SMD=0.00, 95% CI [-0.30-0.31]; P=0.98).
CONCLUSIONS CONCLUSIONS
Weaning failure is associated with parameters indicating worse LV diastolic function (E/e', e' wave, E wave) and increased LV filling pressure (E/e' ratio). The association between weaning failure and LV systolic dysfunction as evaluated by LVEF is more unclear. More studies are needed to clarify this aspect and regarding the role of right ventricular function.

Identifiants

DOI: 10.1016/j.bja.2020.07.059 PMID: 32988600
pubmed: 32988600
pii: S0007-0912(20)30684-X
doi: 10.1016/j.bja.2020.07.059
pii:
doi:

Types de publication

Journal Article Meta-Analysis Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

319-330

Informations de copyright

Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

Auteurs

Filippo Sanfilippo (F)

Department of Anesthesia and Intensive Care, A.O.U. 'Policlinico-Vittorio Emanuele', Catania, Italy. Electronic address: filipposanfi@yahoo.it.

Davide Di Falco (D)

School of Anaesthesia and Intensive Care, University Hospital 'G. Rodolico', University of Catania, Catania, Italy.

Alberto Noto (A)

Department of Anesthesia and Critical Care, A.O.U. Policlinico 'G. Martino', University of Messina, Messina, Italy.

Cristina Santonocito (C)

Department of Anesthesia and Intensive Care, A.O.U. 'Policlinico-Vittorio Emanuele', Catania, Italy.

Andrea Morelli (A)

Department of Internal Clinical, Anesthesiological and Cardiovascular Sciences, University of Rome, 'La Sapienza', Rome, Italy.

Elena Bignami (E)

Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy.

Sabino Scolletta (S)

Department of Urgency and Emergency, of Organ Transplantation, Anesthesia and Intensive Care, Siena University Hospital, Siena, Italy.

Antoine Vieillard-Baron (A)

Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne-Billancourt, France; INSERM, UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France.

Marinella Astuto (M)

Department of Anesthesia and Intensive Care, A.O.U. 'Policlinico-Vittorio Emanuele', Catania, Italy; School of Anaesthesia and Intensive Care, University Hospital 'G. Rodolico', University of Catania, Catania, Italy; Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy.

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Classifications MeSH

questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic cardiovasculaire › Tests de la fonction cardiaque › Échocardiographie › Association of weaning failure from mechanical...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Association of weaning failure from mechanical...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Association of weaning failure from mechanical...
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Association of weaning failure from mechanical...
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Sevrage de la ventilation mécanique › Association of weaning failure from mechanical...