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Association of weaning failure from mechanical ventilation with transthoracic echocardiography parameters: a systematic review and meta-analysis.

Abstract：

BACKGROUND:Weaning from mechanical ventilation is a challenging step during recovery from critical illness. Weaning failure or early reintubation are associated with increased morbidity and mortality, exposing patients to life-threatening complications. Cardiac dysfunction represents the most common cause of weaning failure. We conducted a systematic review and meta-analysis to evaluate the association between transthoracic echocardiographic parameters and weaning failure. METHODS:We performed a systematic search of MEDLINE and EMBASE screening for prospective studies providing echocardiographic data collected just before the beginning of spontaneous breathing trial and outcome of the weaning attempt. We primarily focused on parameters currently recommended for evaluation of left ventricular (LV) systolic or diastolic dysfunction. RESULTS:We included 11 studies in our primary analysis, which included data on LV ejection fraction (LVEF, n=10 studies) and parameters recommended for the assessment of LV diastolic function (E/e' ratio n=10; E/A ratio n=9; E wave n=8; and e' wave n=7). Weaning failure was significantly associated to a higher E/e' ratio (standardised mean difference [SMD]=1.70, 95% confidence interval [CI; 0.78-2.62]; P<0.001), lower e' wave (SMD=-1.22, 95% CI [-2.33 to -0.11]; P=0.03), and higher E wave (SMD=0.97, 95% CI [0.29-1.65]; P=0.005). We found no association between weaning failure and LVEF (SMD=-0.86, 95% CI [-1.92-0.20]; P=0.11) and E/A ratio (SMD=0.00, 95% CI [-0.30-0.31]; P=0.98). CONCLUSIONS:Weaning failure is associated with parameters indicating worse LV diastolic function (E/e', e' wave, E wave) and increased LV filling pressure (E/e' ratio). The association between weaning failure and LV systolic dysfunction as evaluated by LVEF is more unclear. More studies are needed to clarify this aspect and regarding the role of right ventricular function.

journal_name

Br J Anaesth

journal_title

British journal of anaesthesia

authors

Sanfilippo F,Di Falco D,Noto A,Santonocito C,Morelli A,Bignami E,Scolletta S,Vieillard-Baron A,Astuto M

doi

10.1016/j.bja.2020.07.059

subject

Has Abstract

pub_date

2021-01-01 00:00:00

pages

319-330

issue

eissn

0007-0912

issn

1471-6771

pii

S0007-0912(20)30684-X

journal_volume

126

pub_type

杂志文章,meta分析

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Association of weaning failure from mechanical ventilation with transthoracic echocardiography parameters: a systematic review and meta-analysis.