Prospective Observational Study on Evaluation of Cardiac Dysfunction Induced during the Weaning Process
Havaldar Amarja1, Krishna Bhuvana1, Sampath Sriram1
1Department of Critical Care Medicine, St. John's Hospital, Bengaluru, Karnataka, India.
Summary
Cardiac dysfunction during mechanical ventilation weaning can occur and may not be evident until after extubation. Echocardiography post-extubation can help identify patients at risk for reintubation.
Area of Science:
- Critical Care Medicine
- Cardiology
- Pulmonary Medicine
Background:
- Cardiac dysfunction can arise during mechanical ventilation weaning, even without pre-existing heart disease.
- Mechanisms include altered intrathoracic pressure, systemic vascular resistance, preload, and afterload, impacting heart-lung interactions.
Purpose of the Study:
- To determine if assessing cardiac dysfunction during the weaning process can predict extubation outcomes.
- To identify potential indicators of extubation failure.
Main Methods:
- A prospective observational study involving 161 adult patients planned for extubation.
- Spontaneous breathing trial (SBT) using pressure support-positive end-expiratory pressure (PS-PEEP) was employed for weaning.
- Echocardiography was performed pre-extubation and within six hours post-extubation to assess cardiac function; extubation failure was defined as reintubation within 48 hours.
Main Results:
- Twenty-one patients (13.04%) experienced extubation failure.
- Post-extubation E/e' was significantly higher in the extubation failure group (9.30 vs. 7.71, p=0.018).
- Extubation failure was associated with longer ICU length of stay and increased ICU mortality.
Conclusions:
- E/e' during the weaning trial did not predict extubation success in this study.
- Cardiac dysfunction induced by weaning may be masked during the trial and manifest post-extubation.
- Post-extubation echocardiographic assessment is crucial for identifying patients at risk of reintubation.
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