Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Annals of Intensive Care
Published in: Annals of Intensive Care 1/2018

Open Access 01-12-2018 | Research

Cardiac function during weaning failure: the role of diastolic dysfunction

Authors: Ferran Roche-Campo, Alexandre Bedet, Emmanuel Vivier, Laurent Brochard, Armand Mekontso Dessap

Published in: Annals of Intensive Care | Issue 1/2018

Login to get access

Abstract

Background

Cardiac dysfunction is a common cause of weaning failure. Weaning shares some similarities with a cardiac stress test and may challenge active phases of the cardiac cycle-like ventricular contractility and relaxation. This study aimed at assessing systolic and diastolic function during the weaning process and scrutinizing their dynamics during weaning trials.

Methods

Echocardiography was performed during baseline ventilator settings to assess cardiac function at the initiation of the weaning process and at the start and the end of consecutive weaning trials (performed at day-1, day-2, and before extubation if applicable) to explore the evolution of left ventricle contractility and relaxation in a subset of patients.

Results

Among 67 patients included, weaning was prolonged (≥ 7 days) in 18 (27%) patients and short (< 7 days) in 49 (73%). Prevalence of systolic dysfunction and isolated diastolic dysfunction before the initiation of weaning process were 37 and 17%, respectively. Isolated diastolic dysfunction was more frequent in patients with prolonged weaning as compared to their counterparts. Thirty-one patients were explored by echocardiography during consecutive weaning trials. An increase in filling pressures with an alteration of ventricular relaxation (as assessed by a decrease in tissue Doppler early mitral diastolic wave velocity) was found during failed weaning trials.

Conclusions

Isolated diastolic dysfunction was associated with a prolongation of weaning. Increased filling pressures with left ventricle relaxation impairment may be a key mechanism of weaning trial failure.
Appendix
Available only for authorised users
Literature
1.
Esteban A, Alia I, Ibañez J, Benito S, Tobin MJ. Modes of mechanical ventilation and weaning: a National Survey of Spanish Hospitals. Chest. 1994;106(4):1188–93.CrossRefPubMed
2.
Béduneau G, Pham T, Schortgen F, Piquilloud L, Zogheib E, Jonas M, et al. Epidemiology of weaning outcome according to a new definition. The WIND study. Am J Respir Crit Care Med. 2016;195(6):772–83.CrossRef
3.
Liu J, Shen F, Teboul J-L, Anguel N, Beurton A, Bezaz N, et al. Cardiac dysfunction induced by weaning from mechanical ventilation: incidence, risk factors, and effects of fluid removal. Crit Care. 2016;20(1):369.CrossRefPubMedPubMedCentral
4.
Thille AW, Boissier F, Ben Ghezala H, Razazi K, Mekontso-Dessap A, Brun-Buisson C. Risk factors for and prediction by caregivers of extubation failure in ICU patients: a prospective study*. Crit Care Med. 2015;43(3):613–20.CrossRefPubMed
5.
Papanikolaou J, Makris D, Saranteas T, Karakitsos D, Zintzaras E, Karabinis A, et al. New insights into weaning from mechanical ventilation: left ventricular diastolic dysfunction is a key player. Intensive Care Med. 2011;37(12):1976–85.CrossRefPubMed
6.
Konomi I, Tasoulis A, Kaltsi I, Karatzanos E, Vasileiadis I, Temperikidis P, et al. Left ventricular diastolic dysfunction–an independent risk factor for weaning failure from mechanical ventilation. Anaesth Intensive Care. 2016;44(4):466–73.PubMed
7.
Ha J-W, Lulic F, Bailey KR, Pellikka PA, Seward JB, Tajik AJ, et al. Effects of treadmill exercise on mitral inflow and annular velocities in healthy adults. Am J Cardiol. 2003;91(1):114–5.CrossRefPubMed
8.
Burgess MI, Jenkins C, Sharman JE, Marwick TH. Diastolic stress echocardiography: hemodynamic validation and clinical significance of estimation of ventricular filling pressure with exercise. J Am Coll Cardiol. 2006;47(9):1891–900.CrossRefPubMed
9.
Chattopadhyay S, Alamgir MF, Nikitin NP, Rigby AS, Clark AL, Cleland JGF. Lack of diastolic reserve in patients with heart failure and normal ejection fractionclinical perspective. Circ Heart Fail. 2010;3(1):35–43.CrossRefPubMed
10.
Pinsky MR. Breathing as exercise: the cardiovascular response to weaning from mechanical ventilation. Intensive Care Med. 2000;26(9):1164–6.CrossRefPubMed
11.
Cabello B, Thille AW, Roche-Campo F, Brochard L, Gómez FJ, Mancebo J. Physiological comparison of three spontaneous breathing trials in difficult-to-wean patients. Intensive Care Med. 2010;36(7):1171–9.CrossRefPubMed
12.
Mekontso Dessap A, Roche-Campo F, Kouatchet A, Tomicic V, Beduneau G, Sonneville R, et al. Natriuretic peptide–driven fluid management during ventilator weaning. Am J Respir Crit Care Med. 2012;186(12):1256–63.CrossRefPubMed
13.
Lellouche F, Mancebo J, Jolliet P, Roeseler J, Schortgen F, Dojat M, et al. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med. 2006;174(8):894–900.CrossRefPubMedPubMedCentral
14.
Peñuelas O, Frutos-Vivar F, Fernández C, Anzueto A, Epstein SK, Apezteguía C, et al. Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation. Am J Respir Crit Care Med. 2011;184(4):430–7.CrossRefPubMed
15.
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200.CrossRefPubMed
16.
Garcia MJ, Thomas JD, Klein AL. New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol. 1998;32(4):865–75.CrossRefPubMed
17.
Kasner M, Westermann D, Steendijk P, Gaub R, Wilkenshoff U, Weitmann K, et al. Utility of Doppler Echocardiography And Tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction. Circulation. 2007;116(6):637–47.CrossRefPubMed
18.
Paulus WJ, Tschöpe C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007;28(20):2539–50.CrossRefPubMed
19.
Nikitin NP, Loh PH, de Silva R, Ghosh J, Khaleva OY, Goode K, et al. Prognostic value of systolic mitral annular velocity measured with Doppler tissue imaging in patients with chronic heart failure caused by left ventricular systolic dysfunction. Heart. 2006;92(6):775–9.CrossRefPubMed
20.
Seo J-S, Kim D-H, Kim W-J, Song J-M, Kang D-H, Song J-K. Peak systolic velocity of mitral annular longitudinal movement measured by pulsed tissue Doppler imaging as an index of global left ventricular contractility. Am J Physiol Heart Circ Physiol. 2010;298(5):H1608–15.CrossRefPubMed
21.
Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quiñones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30(6):1527–33.CrossRefPubMed
22.
Sohn D-W, Chai I-H, Lee D-J, Kim H-C, Kim H-S, Oh B-H, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol. 1997;30(2):474–80.CrossRefPubMed
23.
Dujardin KS, Enriquez-Sarano M, Bailey KR, Nishimura RA, Seward JB, Tajik AJ. Grading of mitral regurgitation by quantitative Doppler echocardiography: calibration by left ventricular angiography in routine clinical practice. Circulation. 1997;96(10):3409–15.CrossRefPubMed
24.
Zapata L, Vera P, Roglan A, Gich I, Ordonez-Llanos J, Betbesé AJ. B-type natriuretic peptides for prediction and diagnosis of weaning failure from cardiac origin. Intensive Care Med. 2011;37(3):477–85.CrossRefPubMed
25.
Moschietto S, Doyen D, Grech L, Dellamonica J, Hyvernat H, Bernardin G. Transthoracic echocardiography with Doppler tissue imaging predicts weaning failure from mechanical ventilation: evolution of the left ventricle relaxation rate during a spontaneous breathing trial is the key factor in weaning outcome. Crit Care. 2012;16(3):R81.CrossRefPubMedPubMedCentral
26.
27.
Grasso S, Leone A, De Michele M, Anaclerio R, Cafarelli A, Ancona G, et al. Use of N-terminal pro-brain natriuretic peptide to detect acute cardiac dysfunction during weaning failure in difficult-to-wean patients with chronic obstructive pulmonary disease *. Crit Care Med. 2007;35(1):96–105.CrossRefPubMed
28.
Selby DE, Palmer BM, LeWinter MM, Meyer M. Tachycardia-induced diastolic dysfunction and resting tone in myocardium from patients with normal ejection fraction. J Am Coll Cardiol. 2011;58(2):147–54.CrossRefPubMedPubMedCentral
29.
30.
Buda AJ, Pinsky MR, Ingels NBJ, Daughters GTI, Stinson EB, Alderman EL. Effect of intrathoracic pressure on left ventricular performance. N Engl J Med. 1979;301(9):453–9.CrossRefPubMed
31.
Westermann D, Kasner M, Steendijk P, Spillmann F, Riad A, Weitmann K, et al. Role of left ventricular stiffness in heart failure with normal ejection fraction. Circulation. 2008;117(16):2051–60.CrossRefPubMed
32.
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF III, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277–314.CrossRefPubMed
33.
Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation. 2000;102(15):1788–94.CrossRefPubMed
34.
35.
Lamia B, Maizel J, Ochagavia A, Chemla D, Osman D, Richard C, et al. Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation*. Crit Care Med. 2009;37(5):1696–701.CrossRefPubMed
36.
Hasegawa H, Little WC, Ohno M, Brucks S, Morimoto A, Cheng H-J, et al. Diastolic mitral annular velocity during the development of heart failure. J Am Coll Cardiol. 2003;41(9):1590–7.CrossRefPubMed
37.
Graham RJ, Gelman JS, Donelan L, Mottram PM, Peverill RE. Effect of preload reduction by haemodialysis on new indices of diastolic function 1979. Clin Sci Lond Engl. 2003;105(4):499–506.CrossRef
38.
Nagueh SF, Sun H, Kopelen HA, Middleton KJ, Khoury DS. Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler. J Am Coll Cardiol. 2001;37(1):278–85.CrossRefPubMed
39.
Borlaug BA, Nishimura RA, Sorajja P, Lam CSP, Redfield MM. Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fractionclinical perspective. Circ Heart Fail. 2010;3(5):588–95.CrossRefPubMedPubMedCentral
40.
Borlaug BA, Jaber WA, Ommen SR, Lam CSP, Redfield MM, Nishimura RA. Diastolic relaxation and compliance reserve during dynamic exercise in heart failure with preserved ejection fraction. Heart Br Card Soc. 2011;97(12):964–9.CrossRef
41.
Holland DJ, Prasad SB, Marwick TH. Contribution of exercise echocardiography to the diagnosis of heart failure with preserved ejection fraction (HFpEF). Heart. 2010;96(13):1024–8.CrossRefPubMed
42.
Erdei T, Smiseth OA, Marino P, Fraser AG. A systematic review of diastolic stress tests in heart failure with preserved ejection fraction, with proposals from the EU-FP7 MEDIA study group. Eur J Heart Fail. 2014;16(12):1345–61.CrossRefPubMed
43.
Kitzman DW, Gardin JM, Gottdiener JS, Arnold A, Boineau R, Aurigemma G, et al. Importance of heart failure with preserved systolic function in patients ≥ 65 years of age. Am J Cardiol. 2001;87(4):413–9.CrossRefPubMed
44.
The National Heart Lung, Network BIARDS (ARDS) CT. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564–75.CrossRef
45.
Routsi C, Stanopoulos I, Zakynthinos E, Politis P, Papas V, Zervakis D, et al. Nitroglycerin can facilitate weaning of difficult-to-wean chronic obstructive pulmonary disease patients: a prospective interventional non-randomized study. Crit Care Lond Engl. 2010;14(6):R204.CrossRef
46.
Edelmann F, Gelbrich G, Düngen H-D, Fröhling S, Wachter R, Stahrenberg R, et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction. J Am Coll Cardiol. 2011;58(17):1780–91.CrossRefPubMed
Metadata
Title
Cardiac function during weaning failure: the role of diastolic dysfunction
Authors
Ferran Roche-Campo
Alexandre Bedet
Emmanuel Vivier
Laurent Brochard
Armand Mekontso Dessap
Publication date
01-12-2018
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2018
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-017-0348-4

Other articles of this Issue 1/2018

Annals of Intensive Care 1/2018 Go to the issue

Research

Effect on comfort of administering bubble-humidified or dry oxygen: the Oxyrea non-inferiority randomized study

Review

Effectiveness of antimicrobial-coated central venous catheters for preventing catheter-related blood-stream infections with the implementation of bundles: a systematic review and network meta-analysis

Research

Impact of oversedation prevention in ventilated critically ill patients: a randomized trial—the AWARE study

Research

Epidemiology, causes, evolution and outcome in a single-center cohort of 1116 critically ill patients with hypoxic hepatitis

Research

Hypothermic total liquid ventilation after experimental aspiration-associated acute respiratory distress syndrome

Research

Oleic acid chlorohydrin, a new early biomarker for the prediction of acute pancreatitis severity in humans