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BMC Cardiovascular Disorders

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Open Access 01-12-2010 | Research article

Relation of tricuspid annular displacement and tissue Doppler imaging velocities with duration of weaning in mechanically ventilated patients with acute pulmonary edema

Authors: Vasilios E Papaioannou, Dimitrios A Stakos, Christos K Dragoumanis, Ioannis A Pneumatikos

Published in: BMC Cardiovascular Disorders | Issue 1/2010

Abstract

Background

Liberation from the ventilator is a difficult task, whereas early echocardiographic indices of weaning readiness are still lacking. The aim of this study was to test whether tricuspid annular plane systolic excursion (TAPSE) and right ventricular (RV) systolic (Sm) and diastolic (Em & Am) tissue Doppler imaging (TDI) velocities are related with duration of weaning in mechanically ventilated patients with acute respiratory failure due to acute pulmonary edema (APE).

Methods

Detailed quantification of left and right ventricular systolic and diastolic function was performed at admission to the Intensive Care Unit by Doppler echocardiography, in a cohort of 32 mechanically ventilated patients with APE. TAPSE and RV TDI velocities were compared between patients with and without prolonged weaning (≥ or < 7 days from the first weaning trial respectively), whereas their association with duration of ventilation and left ventricular (LV) echo-derived indices was tested with multivariate linear and logistic regression analysis.

Results

Patients with prolonged weaning (n = 12) had decreased TAPSE (14.59 ± 1.56 vs 19.13 ± 2.59 mm), Sm (8.68 ± 0.94 vs 11.62 ± 1.77 cm/sec) and Em/Am ratio (0.98 ± 0.80 vs 2.62 ± 0.67, p <0.001 for all comparisons) and increased Ε/e' (11.31 ± 1.02 vs 8.98 ± 1.70, p <0.001) compared with subjects without prolonged weaning (n = 20). Logistic regression analysis revealed that TAPSE (R² = 0.53, beta slope = 0.76, p < 0.001), Sm (R² = 0.52, beta = 0.75, p < 0.001) and Em/Am (R² = 0.57, beta = 0.32, p < 0.001) can predict length of weaning ≥ 7 days. The above measures were also proven to correlate significantly with Ε/e' (r = -0.83 for TAPSE, r = -0.87 for Sm and r = -0.79 for Em/Am, p < 0.001 for all comparisons).

Conclusions

We suggest that in mechanically ventilated patients with APE, low TAPSE and RV TDI velocities upon admission are associated with delayed liberation from mechanical ventilation, probably due to more severe LV heart failure.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2261/10/20/prepub

Title: Relation of tricuspid annular displacement and tissue Doppler imaging velocities with duration of weaning in mechanically ventilated patients with acute pulmonary edema
Authors: Vasilios E Papaioannou
Dimitrios A Stakos
Christos K Dragoumanis
Ioannis A Pneumatikos
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: BMC Cardiovascular Disorders / Issue 1/2010
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/1471-2261-10-20

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Relation of tricuspid annular displacement and tissue Doppler imaging velocities with duration of weaning in mechanically ventilated patients with acute pulmonary edema

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Methods

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Conclusions

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