Left ventricular systolic function and mechanical ventilation weaning failure: An updated systematic review and...

Area of Science:

• Cardiology
• Critical Care Medicine
• Pulmonary Medicine

Background:

• Left ventricular (LV) systolic dysfunction's impact on weaning from mechanical ventilation remains uncertain.
• Echocardiographic parameters are crucial for assessing cardiac function in critically ill patients.

Purpose of the Study:

• To conduct an updated meta-analysis on the association between LV ejection fraction (LVEF) and weaning failure.
• To evaluate other echocardiographic parameters, including diastolic function, in relation to weaning outcomes.

Main Methods:

• Systematic search of MEDLINE and EMBASE for prospective studies.
• Inclusion of studies reporting weaning outcomes and echocardiographic data prior to spontaneous breathing trial (SBT).
• Meta-analysis of LVEF, E/e' ratio, E velocity, deceleration time, and e' velocity.

Main Results:

• Lower LVEF was associated with weaning failure (MD: -4.71), though with low certainty and not robust on trial sequential analysis.
• Higher E/e' ratio (MD: 1.90), increased E velocity (MD: 8.32), and shorter deceleration time (MD: -12.01) were significantly associated with weaning failure.
• e' velocity did not show a significant association with weaning failure (MD: -0.59).

Conclusions:

• A fragile association between poorer LV systolic function (LVEF) and weaning failure was identified, likely not clinically relevant.
• Elevated E/e' ratio and other diastolic parameters are confirmed predictors of weaning failure.
• e' velocity is not a reliable predictor of weaning failure in this context.