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Left ventricular function during weaning of patients with chronic obstructive pulmonary disease
C Richard1, J L Teboul, F Archambaud
1Service de Réanimation Médicale, Hôpital de Bicêtre, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France.
Objective:
Determine the evolution of left ventricular ejection fraction during weaning.
Design:
Prospective study.
Setting:
Intensive care unit of a university teaching hospital.
Patients And Participants:
12 consecutive mechanically ventilated patients, without documented coronary artery disease, suffering from acute exacerbation of chronic obstructive pulmonary disease and able to be weaned.
Measurements And Results:
Left ventricular ejection fraction was determined during mechanical ventilation, inspiratory pressure support (10 cmH2O) and spontaneous ventilation with constant inspiratory oxygen fraction using technetium 99m radionuclide angiography. Spontaneous ventilation induced a significant decrease in left ventricular ejection fraction from 54.5 +/- 12.4 to 47.0 +/- 13% (p < 0.01). Inspiratory pressure support induced a slight but non-significant decrease in left ventricular ejection fraction from 55.0 +/- 12.1 to 50.3 +/- 12.4%. Left ventricular ejection fraction was homogeneously reduced by spontaneous ventilation without patent regional wall motion abnormalities of the left ventricle. Myocardial 201thallium imaging performed 15 min after weaning showed a normal perfusion in the left ventricle anterior and posterior free wall.
Conclusion:
Weaning of patients suffering from chronic obstructive pulmonary disease without coronary artery disease induced a significant reduction in left ventricular ejection fraction. The non significant decrease in left ventricular ejection fraction observed with inspiratory pressure support suggested that our results might be explained by a weaning induced increase in afterload.