Echocardiography a help in the weaning process.docVIP

Caille et al. Critical Care 2010, 14:R120 /content/14/3/R120 RESEARCH Open Access Echocardiography: a help in the weaning processResearch Vincent Caille1,2, Jean-Bernard Amiel3,4,5, Cyril Charron1,2, Guillaume Belliard1,2, Antoine Vieillard-Baron1,2 and Philippe Vignon*3,4,5 Abstract Introduction: To evaluate the ability of transthoracic echocardiography (TTE) to detect the effects of spontaneous breathing trial (SBT) on central hemodynamics and to identify indices predictive of cardiac-related weaning failure. Methods: TTE was performed just before and at the end of a 30-min SBT in 117 patients fulfilling weaning criteria. Maximal velocities of mitral E and A waves, deceleration time of E wave (DTE), maximal velocity of E wave (tissue Doppler at the lateral mitral annulus), and left ventricular (LV) stroke volume were measured. Values of TTE parameters were compared between baseline (pressure support ventilation) and SBT in all patients and according to LV ejection fraction (EF): 50% (n = 58), 35% to 50% (n = 30), and 35% (n = 29). Baseline TTE indices were also compared between patients who were weaned (n = 94) and those who failed (n = 23). Results: Weaning failure was of cardiac origin in 20/23 patients (87%). SBT resulted in a significant increase in cardiac output and E/A, and a shortened DTE. At baseline, DTE was significantly shorter in patients with LVEF 35% when compared to other subgroups (median [25th-75th percentiles]: 119 ms [90-153]; vs. 187 ms [144-224] vs. 174 ms [152- 193]; P 0.01) and E/E was greater (7.9 [5.4-9.1] vs. 6.0 [5.3-9.0] vs. 5.2 [4.7-6.0]; P 0.01). When compared to patients who were successfully weaned, those patients who failed exhibited at baseline a significantly lower LVEF (36% [27-55] vs. 51% [43-55]: P = 0.04) and higher E/E (7.0 [5.0-9.2] vs. 5.6 [5.2-6.3]: P = 0.04). Conclusions: TTE detects SBT-induced changes in central hemodynamics. When performed by an experienced operator prior to SBT, TTE helps in identify