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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2018

Open Access 01-12-2018 | Research article

Left ventricular-arterial coupling is associated with prolonged mechanical ventilation in severe post-cardiac surgery patients: an observational study

Authors: Xu Wang, Yun Long, Huaiwu He, Guangliang Shan, Rui Zhang, Na Cui, Hao Wang, Xiang Zhou, Xi Rui, Wanglin Liu

Published in: BMC Anesthesiology | Issue 1/2018

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Abstract

Background

Weaning post-cardiac surgery patients from mechanical ventilation (MV) poses a big challenge to these patients. Optimized left ventricular-arterial coupling (VAC) may be crucial for reducing the MV duration of these patients. However, there is no research exploring the relationship between VAC and the duration of MV. We performed this study to investigate the relationship between left ventricular-arterial coupling (VAC) and prolonged mechanical ventilation (MV) in severe post-cardiac surgery patients.

Methods

This was a single-center retrospective study of 56 severe post-cardiac surgery patients from January 2015 to December 2017 at the Department of Critical Care Medicine of Peking Union Medical College Hospital. Patients were divided into two groups according to the duration of MV (PMV group: prolonged mechanical ventilation group, MV > 6 days; Non-PMV group: non-prolonged mechanical ventilation group, MV ≤ 6 days). Hemodynamics and tissue perfusion data were collected or calculated at admission (T0) and 48 h after admission (T1) to the ICU.

Results

In terms of hemodynamic and tissue perfusion data, there were no differences between the two groups at admission (T0). Compared with the non-prolonged MV group after 48 h in the ICU (T1), the prolonged MV group had significantly higher values for heart rate (108 ± 13 vs 97 ± 12, P = 0.018), lactate (2.42 ± 1.24 vs.1.46 ± 0.58, P < 0.001), and Ea/Ees (5.93 ± 1.81 vs. 4.05 ± 1.20, P < 0.001). Increased Ea/Ees (odds ratio, 7.305; 95% CI, 1.181–45.168; P = 0.032) and lactate at T1 (odds ratio, 17.796; 95% CI, 1.377–229.988; P = 0.027) were independently associated with prolonged MV. There was a significant relationship between Ea/EesT1 and the duration of MV (r = 0.512, P < 0.01). The area under the receiver operating characteristic (AUC) of the left VAC for predicting prolonged MV was 0.801, and the cutoff value for Ea/Ees was 5.12, with 65.0% sensitivity and 90.0% specificity.

Conclusions

Left ventricular-arterial coupling was associated with prolonged mechanical ventilation in severe post-cardiac surgery patients. The assessment and optimization of left VAC might be helpful in reducing duration of MV in these patients.
Literature
1.
LoCicero J 3rd, McCann B, Massad M, Joob AW. Prolonged ventilatory support after open-heart surgery. Crit Care Med. 1992;20(7):990–2.CrossRefPubMed
2.
Knapik P, Ciesla D, Borowik D, Czempik P, Knapik T. Prolonged ventilation post cardiac surgery--tips and pitfalls of the prediction game. J Cardiothorac Surg. 2011;6:158.CrossRefPubMedPubMedCentral
3.
Rajakaruna C, Rogers CA, Angelini GD, Ascione R. Risk factors for and economic implications of prolonged ventilation after cardiac surgery. J Thorac Cardiovasc Surg. 2005;130(5):1270–7.CrossRefPubMed
4.
Vagheggini G, Vlad EP, Mazzoleni S, Bortolotti U, Guarracino F, Ambrosino N. Outcomes for difficult-to-wean subjects after cardiac surgery. Respir Care. 2015;60(1):56–62.CrossRefPubMed
5.
Dres M, Teboul JL, Monnet X. Weaning the cardiac patient from mechanical ventilation. Curr Opin Crit Care. 2014;20(5):493–8.CrossRefPubMed
6.
Teboul JL. Weaning-induced cardiac dysfunction: where are we today? Intensive Care Med. 2014;40(8):1069–79.CrossRefPubMed
7.
Rady MY, Ryan T. Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Crit Care Med. 1999;27(2):340–7.CrossRefPubMed
8.
Siddiqui MM, Paras I, Jalal A. Risk factors of prolonged mechanical ventilation following open heart surgery: what has changed over the last decade? Cardiovasc Diagn Ther. 2012;2(3):192–9.PubMedPubMedCentral
9.
Routsi C, Stanopoulos I, Zakynthinos E, Politis P, Papas V, Zervakis D, Zakynthinos S. Nitroglycerin can facilitate weaning of difficult-to-wean chronic obstructive pulmonary disease patients: a prospective interventional non-randomized study. Crit Care. 2010;14(6):R204.CrossRefPubMedPubMedCentral
10.
Sunagawa K, Sagawa K, Maughan WL. Ventricular interaction with the loading system. Ann Biomed Eng. 1984;12(2):163–89.CrossRefPubMed
11.
Sweitzer N, Chirinos JA. Ventricular–arterial coupling in chronic heart failure. Cardiac Failure Rev. 2017;03(01):12.CrossRef
12.
Shigemi K, Fuke S, Une D, Saku K, Shimizu S, Kawada T, Shishido T, Sunagawa K, Sugimachi M. Physiological insights of recent clinical diagnostic and therapeutic technologies for cardiovascular diseases. J Physiol Sci. 2017;67(6):655–72.CrossRefPubMedPubMedCentral
13.
Suga H. Total mechanical energy of a ventricle model and cardiac oxygen consumption. Am J Phys. 1979;236(3):H498–505.
14.
15.
Burkhoff D, Sagawa K. Ventricular efficiency predicted by an analytical model. Am J Phys. 1986;250(6 Pt 2):R1021–7.
16.
Antonini-Canterin F, Poli S, Vriz O, Pavan D, Bello VD, Nicolosi GL. The ventricular-arterial coupling: from basic pathophysiology to clinical application in the echocardiography laboratory. J Cardiovasc Echogr. 2013;23(4):91–5.CrossRefPubMedPubMedCentral
17.
Loss SH, de Oliveira RP, Maccari JG, Savi A, Boniatti MM, Hetzel MP, Dallegrave DM, Balzano Pde C, Oliveira ES, Hoher JA, et al. The reality of patients requiring prolonged mechanical ventilation: a multicenter study. Rev Bras Ter Intensiva. 2015;27(1):26–35.CrossRefPubMedPubMedCentral
18.
Busl KM, Ouyang B, Boland TA, Pollandt S, Temes RE. Prolonged mechanical ventilation is associated with pulmonary complications, increased length of stay, and unfavorable discharge destination among patients with subdural hematoma. J Neurosurg Anesthesiol. 2015;27(1):31–6.CrossRefPubMed
19.
Lemaire F, Teboul JL, Cinotti L, Giotto G, Abrouk F, Steg G, Macquin-Mavier I, Zapol WM. Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology. 1988;69(2):171–9.CrossRefPubMed
20.
Bombardini T, Costantino MF, Sicari R, Ciampi Q, Pratali L, Picano E. End-systolic elastance and ventricular-arterial coupling reserve predict cardiac events in patients with negative stress echocardiography. Biomed Res Int. 2013;2013:235194.CrossRefPubMedPubMedCentral
21.
Matsumoto K, Tanaka H, Ooka J, Motoji Y, Sawa T, Mochizuki Y, Ryo K, Tatsumi K, Hirata K-i. Significant prognostic impact of improvement in ventriculo-arterial coupling induced by dobutamine stress on cardiovascular outcome for patients with dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging. 2016;17(11):1296–304.CrossRefPubMed
22.
Guarracino F, Cariello C, Danella A, Doroni L, Lapolla F, Stefani M, Baldassarri R, Vullo C. Effect of levosimendan on ventriculo-arterial coupling in patients with ischemic cardiomyopathy. Acta Anaesthesiol Scand. 2007;51(9):1217–24.CrossRefPubMed
23.
Binkley PF, Van Fossen DB, Nunziata E, Unverferth DV, Leier CV. Influence of positive inotropic therapy on pulsatile hydraulic load and ventricular-vascular coupling in congestive heart failure. J Am Coll Cardiol. 1990;15(5):1127–35.CrossRefPubMed
24.
Ouanes-Besbes L, Ouanes I, Dachraoui F, Dimassi S, Mebazaa A, Abroug F. Weaning difficult-to-wean chronic obstructive pulmonary disease patients: a pilot study comparing initial hemodynamic effects of levosimendan and dobutamine. J Crit Care. 2011;26(1):15–21.CrossRefPubMed
25.
Burggraf GW, Parker JO. Effects of dextran infusion on left ventricular volume and pressure in man. Catheter Cardiovasc Diagn. 1978;4(4):383–90.CrossRef
26.
Arnold G, Kosche F, Miessner E, Neitzert A, Lochner W. The importance of the perfusion pressure in the coronary arteries for the contractility and the oxygen consumption of the heart. Pflugers Arch Gesamte Physiol Menschen Tiere. 1968;299(4):339–56.CrossRefPubMed
27.
Papaioannou VE, Stakos DA, Dragoumanis CK, Pneumatikos IA. Relation of tricuspid annular displacement and tissue Doppler imaging velocities with duration of weaning in mechanically ventilated patients with acute pulmonary edema. BMC Cardiovasc Disord. 2010;10:20.CrossRefPubMedPubMedCentral
28.
Hofer CK, Furrer L, Matter-Ensner S, Maloigne M, Klaghofer R, Genoni M, Zollinger A. Volumetric preload measurement by thermodilution: a comparison with transoesophageal echocardiography. Br J Anaesth. 2005;94(6):748–55.CrossRefPubMed
29.
30.
31.
Faconti L, Bruno RM, Ghiadoni L, Taddei S, Virdis A. Ventricular and vascular stiffening in aging and hypertension. Curr Hypertens Rev. 2015;11(2):100–9.CrossRefPubMed
32.
Coutinho T, Borlaug BA, Pellikka PA, Turner ST, Kullo IJ. Sex differences in arterial stiffness and ventricular-arterial interactions. J Am Coll Cardiol. 2013;61(1):96–103.CrossRefPubMed
33.
Gray R, Maddahi J, Berman D, Raymond M, Waxman A, Ganz W, Matloff J, Swan HJ. Scintigraphic and hemodynamic demonstration of transient left ventricular dysfunction immediately after uncomplicated coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1979;77(4):504–10.PubMed
34.
Breisblatt WM, Stein KL, Wolfe CJ, Follansbee WP, Capozzi J, Armitage JM, Hardesty RL. Acute myocardial dysfunction and recovery: a common occurrence after coronary bypass surgery. J Am Coll Cardiol. 1990;15(6):1261–9.CrossRefPubMed
Metadata
Title
Left ventricular-arterial coupling is associated with prolonged mechanical ventilation in severe post-cardiac surgery patients: an observational study
Authors
Xu Wang
Yun Long
Huaiwu He
Guangliang Shan
Rui Zhang
Na Cui
Hao Wang
Xiang Zhou
Xi Rui
Wanglin Liu
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2018
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-018-0649-7

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