On the role of left ventricular diastolic function in the critically ill patient

Excerpt

In the December 2011 issue of Intensive Care Medicine, Papanikolaou and coworkers [1] reported their investigation into the diagnostic performance of echocardiography in predicting the outcome of weaning, and especially the role of left ventricular (LV) diastolic function in weaning failure. The main result is presented in Fig. 2 of their study [1]. Among the 23 patients without LV diastolic dysfunction before the spontaneous breathing trial (SBT), eight failed to be weaned (35%), whereas among the 20 patients with moderate to severe LV diastolic dysfunction, 80% failed to be weaned. In patients with mild diastolic dysfunction, 3/7 (57%) failed. Overall, cardiogenic pulmonary edema was suspected to be the cause of weaning failing in 65% of cases [1]. The originality of the study, which renders it especially interesting, is that Papanikolaou and coworkers only included patients with preserved LV systolic function. Caille et al. [2] previously reported similar results in 117 unselected patients. In many patients, however, LV diastolic dysfunction was associated with systolic dysfunction, which is also strongly associated with weaning failure [2]. In the study by Lamia et al. [3] increase in LV filling pressures related to SBT detected by Doppler echocardiography was very predictive of weaning failure, but the population was highly selected, i.e., patients with already two failed SBTs, and around 20% of patients had a decreased LV ejection fraction. …