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Hemodynamic monitoring during weaning from mechanical ventilation in critically ill pediatric patients: a prospective
Tarek Ahmed Abdelgawad1, Hanan M Ibrahim1, Eman Mohamed Elsayed2
1Department of Pediatric Intensive Care Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Insights
Pediatric weaning trials reveal significant hemodynamic changes, with lower cardiac index and TAPSE predicting cardiac-related weaning failure. Echocardiography and noninvasive cardiometry aid in detecting these changes.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular physiology
- Mechanical ventilation weaning
Background:
- Cardiovascular dysfunction is a key factor in pediatric weaning failure from mechanical ventilation.
- Understanding cardiopulmonary changes during weaning is crucial for early detection of cardiac-related failure.
- This study investigates hemodynamic shifts during weaning trials in children.
Purpose of the Study:
- To assess the impact of weaning trials on central hemodynamics in children.
- To identify hemodynamic indices that predict cardiac-related weaning failure.
- To evaluate the utility of echocardiography and noninvasive cardiometry in monitoring these changes.
Main Methods:
- Prospective observational study in a Pediatric Intensive Care Unit (PICU).
- Included 50 mechanically ventilated children (2-30 months) ready for weaning.
- Assessed hemodynamics using echocardiography and noninvasive cardiometry during pressure support ventilation and after spontaneous breathing trials (SBT).
Main Results:
- Weaning trials significantly increased cardiac index (CI), tricuspid annular plane systolic excursion (TAPSE), and E/A ratio, while decreasing right ventricular systolic pressure (RVSP).
- Noninvasive cardiometry showed increased index of contractility (ICON) and CI post-SBT.
- Patients failing extubation (25%) had significantly lower CI and TAPSE.
Conclusions:
- Weaning from mechanical ventilation induces hemodynamic changes in children, potentially indicating ventricular dysfunction.
- Bedside echocardiography effectively detects cardiac dysfunction during weaning.
- Noninvasive cardiometry is a reliable tool supporting echocardiography for monitoring CI trends in PICUs.
Background:
Cardiovascular dysfunction is a significant factor contributing to weaning failure in mechanically ventilated children. Understanding the cardiopulmonary pathophysiological changes that occur during weaning is a prerequisite for the early recognition of weaning failure of cardiovascular origin. This study aimed to assess the effect of weaning trials on central hemodynamics and to identify the indices predictive of cardiac-related weaning failure.
Methods:
This prospective observational study was conducted in the Pediatric Intensive Care Unit (PICU) and included mechanically ventilated patients aged between 2 and 30 months who were on minimal ventilatory settings and ready for weaning. Patients who were hemodynamically unstable, diagnosed with neuromuscular diseases, or diagnosed with cardiac diseases were excluded. Hemodynamic parameters were evaluated during weaning from ventilation via echocardiography and noninvasive cardiometry during pressure support (PS) ventilation and at the end of the spontaneous breathing trial (SBT).
Results:
The study included 50 patients, comprising 30 males (60%) and 20 females (40%) with ages ranging from 2 to 30 months. Echocardiography revealed a significant increase in the cardiac index (CI), tricuspid annular plane systolic excursion (TAPSE), and the E/A ratio at the end of SBT. Moreover, right ventricular systolic pressure (RVSP) significantly decreased. Noninvasive cardiometry revealed a significant increase in the index of contractility (ICON) and CI at the end of SBT (p-value = 0.023 and < 0.001, respectively). Of the 12 (25%) patients who failed their first extubation trial, they exhibited a significantly lower CI and TAPSE (p values = 0.001 and 0.001, respectively).
Conclusion:
This study identified that weaning from mechanical ventilation in children is associated with hemodynamic changes, which can impact weaning success and reveal potential ventricular dysfunction. Bedside echocardiography was found to detect cardiac dysfunctions during weaning, and noninvasive cardiometry was considered a reliable tool that supports echocardiography for detecting changing trends in CI in PICUs. However, accurate values should be confirmed by echocardiography.
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