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Echocardiography: a help in the weaning process

机译：超声心动图：对断奶过程的帮助

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IntroductionTo evaluate the ability of transthoracic echocardiography (TTE) to detect the effects of spontaneous breathing trial (SBT) on central hemodynamics and to identify indices predictive of cardiac-related weaning failure.MethodsTTE was performed just before and at the end of a 30-min SBT in 117 patients fulfilling weaning criteria. Maximal velocities of mitral E and A waves, deceleration time of E wave (DTE), maximal velocity of E' wave (tissue Doppler at the lateral mitral annulus), and left ventricular (LV) stroke volume were measured. Values of TTE parameters were compared between baseline (pressure support ventilation) and SBT in all patients and according to LV ejection fraction (EF): >50% (n = 58), 35% to 50% (n = 30), and <35% (n = 29). Baseline TTE indices were also compared between patients who were weaned (n = 94) and those who failed (n = 23).ResultsWeaning failure was of cardiac origin in 20/23 patients (87%). SBT resulted in a significant increase in cardiac output and E/A, and a shortened DTE. At baseline, DTE was significantly shorter in patients with LVEF <35% when compared to other subgroups (median [25th-75th percentiles]: 119 ms [90-153]; vs. 187 ms [144-224] vs. 174 ms [152-193]; P < 0.01) and E/E' was greater (7.9 [5.4-9.1] vs. 6.0 [5.3-9.0] vs. 5.2 [4.7-6.0]; P < 0.01). When compared to patients who were successfully weaned, those patients who failed exhibited at baseline a significantly lower LVEF (36% [27-55] vs. 51% [43-55]: P = 0.04) and higher E/E' (7.0 [5.0-9.2] vs. 5.6 [5.2-6.3]: P = 0.04).ConclusionsTTE detects SBT-induced changes in central hemodynamics. When performed by an experienced operator prior to SBT, TTE helps in identifying patients at high risk of cardiac-related weaning failure when documenting a depressed LVEF, shortened DTE and increased E/E'. Further studies are needed to evaluate the impact of this screening strategy on the weaning process and patient outcome.
机译：简介为了评估经胸超声心动图（TTE）检测自发呼吸试验（SBT）对中心血流动力学的影响并确定可预测与心脏相关的断奶失败的指标的方法，方法在30分钟之前和结束时进行TTE。 117名符合断奶标准的患者的SBT。测量了二尖瓣E波和A波的最大速度，E波的减速时间（DTE），E'波的最大速度（二尖瓣外侧环的组织多普勒）和左心室（LV）搏动量。比较所有患者的基线（压力支持通气）和SBT之间的TTE参数值，并根据左室射血分数（EF）：> 50％（n = 58），35％至50％（n = 30）和< 35％（n = 29）。断奶患者（n = 94）和失败者（n = 23）的基线TTE指数也进行了比较。结果断奶失败的原因是心脏原因的20/23患者（87％）。 SBT导致心输出量和E / A显着增加，DTE缩短。基线时，LVEF <35％的患者的DTE与其他亚组相比显着缩短（中位[25-75％]：119毫秒[90-153]; 187毫秒[144-224]与174毫秒[ 152-193]; P <0.01）和E / E'更大（7.9 [5.4-9.1]对6.0 [5.3-9.0]对5.2 [4.7-6.0]; P <0.01）。与成功断奶的患者相比，那些失败的患者在基线时LVEF显着降低（36％[27-55]比51％[43-55]：P = 0.04）和更高的E / E'（7.0） [5.0-9.2]与5.6 [5.2-6.3]：P = 0.04）。结论TTE检测SBT诱导的中心血流动力学变化。当由经验丰富的操作员在SBT之前进行操作时，TTE可以帮助他们在记录LVEF降低，DTE缩短和E / E'升高时识别出具有高心脏相关断奶失败风险的患者。需要进一步的研究来评估这种筛查策略对断奶过程和患者预后的影响。

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