@article{3129214,
    title = "New insights into weaning from mechanical ventilation: Left ventricular diastolic dysfunction is a key player",
    author = "Papanikolaou, J. and Makris, D. and Saranteas, T. and Karakitsos, D. and Zintzaras, E. and Karabinis, A. and Kostopanagiotou, G. and Zakynthinos, E.",
    journal = "Intensive Care Medicine Experimental",
    year = "2011",
    volume = "37",
    number = "12",
    pages = "1976-1985",
    issn = "2197-425X",
    doi = "10.1007/s00134-011-2368-0",
    keywords = "adult;  area under the curve;  article;  artificial ventilation;  brain hemorrhage;  clinical article;  female;  heart left ventricle failure;  heart left ventricle filling pressure;  human;  male;  outcome assessment;  prospective study;  sensitivity and specificity;  tissue Doppler imaging;  traumatic brain injury;  adverse effects;  critical illness;  diagnostic imaging;  Doppler echocardiography;  heart left ventricle function;  hemodynamics;  intensive care;  middle aged;  pathophysiology;  physiology;  procedures;  Respiratory Insufficiency;  risk factor;  statistical model;  ventilator weaning, Critical Care;  Critical Illness;  Echocardiography, Doppler;  Female;  Hemodynamics;  Humans;  Logistic Models;  Male;  Middle Aged;  Prospective Studies;  Respiration, Artificial;  Respiratory Insufficiency;  Risk Factors;  Ventilator Weaning;  Ventricular Dysfunction, Left;  Ventricular Function, Left",
    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. © 2011 Copyright jointly held by Springer and ESICM."
}