Cardiac Ischemia During Weaning From Mechanical Ventilation

Chatila, Wissam; Ani, S Hirish J; Guaglianone, Denise; Jacob, Badie; Amoateng-Adjepong, Yaw; Manthous, Constantine A.

doi:10.1378/chest.109.6.1577

Cited by 117 publications

(61 citation statements)

References 16 publications

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“…Participants with unsuccessful SBTs were permitted to have a repeat SBT at the discretion of the managing physician. Patients continued to be screened daily until extubation, 21 2 and ΔPETCO 2 is the change in end-tidal carbon dioxide (PETCO 2 ) between normal breathing and carbon dioxide rebreathing, and S is the slope of the carbon dioxide dissociation curve from hemoglobin.…”

Section: Methodsmentioning

confidence: 99%

“…Among these conditions are myocardial ischemia and congestive heart failure. 1 The decrease in ventilator support during a spontaneous breathing trial (SBT) can increase preload, afterload, and catecholamine release [2][3][4][5] and possibly exacerbate underlying cardiac dysfunction, resulting in pulmonary edema and unsuccessful weaning. These processes may also cause myocardial ischemia, 6 leading to pulmonary edema related to the increased transmural pulmonary artery occlusion pressure associated with decreased myocardial compliance.…”

mentioning

confidence: 99%

“…Indeed, myocardial ischemia can occur during weaning. 2,[7][8][9] Therefore, myocardial ischemia should be considered as an important cause of unsuccessful weaning. In patients with obstructive lung disease, unsuccessful weaning may be associated with worsening dynamic hyperinflation, which may also result in cardiac dysfunction.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Noninvasive Monitoring of Cardiac Output During Weaning From Mechanical Ventilation: A Pilot Study

Tanios

Epstein

Sauser

et al. 2016

American Journal of Critical Care

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Noninvasive Monitoring of Cardiac Output During Weaning From Mechanical Ventilation: A Pilot Study

Tanios

Epstein

Sauser

et al. 2016

American Journal of Critical Care

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“…A marked increase in work of breathing may increase cardiac work and myocardial oxygen demand [5]. Th e increased adrenergic tone may also increase venous return, LV afterload, cardiac work, and myocardial oxygen demand and may thus potentially result in myocardial ischemia in predisposed patients [4,6]. In patients with pre-existing right ventricular (RV) disease, an increase in weaning-induced RV afterload may occur because of hypoxemia or worsening of intrinsic positive end-expiratory pressure (PEEPi) [5].…”

Section: Mechanisms Contributing To the Development Of Weaning-inducementioning

confidence: 99%

Weaning Failure of Cardiac Origin: Recent Advances

Teboul

Monnet

Richard

2010

Intensive Care Medicine

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“…[92][93][94][95] Therefore, STsegment monitoring should be considered intra-and postoperatively, continuing for 24 to 48 h, in patients in any of these high-risk categories.…”

Section: Patients At High Risk For Ischemia After Cardiac or Noncardimentioning

confidence: 99%

Practice Standards for ECG Monitoring in Hospital Settings: Executive Summary and Guide for Implementation

Drew

Funk

2006

Critical Care Nursing Clinics of North America

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Abstract-The goals of electrocardiographic (ECG) monitoring in hospital settings have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, myocardial ischemia, and prolonged QT interval. Whereas computerized arrhythmia analysis is automatic in cardiac monitoring systems, computerized ST-segment ischemia analysis is available only in newer-generation monitors, and computerized QT-interval monitoring is currently unavailable. Even in hospitals with ST-monitoring capability, ischemia monitoring is vastly underutilized by healthcare professionals. Moreover, because no computerized analysis is available for QT monitoring, healthcare professionals must determine when it is appropriate to manually measure QT intervals (eg, when a patient is started on a potentially proarrhythmic drug). The purpose of the present review is to provide 'best practices' for hospital ECG monitoring. Randomized clinical trials in this area are almost nonexistent; therefore, expert opinions are based upon clinical experience and related research in the field of electrocardiography. This consensus document encompasses all areas of hospital cardiac monitoring in both children and adults. The emphasis is on information clinicians need to know to monitor patients safely and effectively. Recommendations are made with regard to indications, timeframes, and strategies to improve the diagnostic accuracy of cardiac arrhythmia, ischemia, and QT-interval monitoring. Currently available ECG lead systems are described, and recommendations related to staffing, training, and methods to improve quality are provided. Key Words: AHA Scientific Statements Ⅲ pediatrics Ⅲ electrocardiography Ⅲ torsade de pointes Ⅲ myocardial infarction Ⅲ tachyarrhythmias Ⅲ ischemia Ⅲ antiarrhythmic agents Ⅲ long-QT syndrome S ince the introduction of electrocardiographic (ECG) monitoring in hospital units Ͼ40 years ago, 1 the goals of monitoring have expanded from simple tracking of heart rate and basic rhythm to the diagnosis of complex arrhythmias, the detection of myocardial ischemia, and the identification of a prolonged QT interval. During the same 4 decades, major improvements have occurred in cardiac monitoring systems, including computerized arrhythmia detection algorithms, STsegment/ischemia monitoring software, improved noisereduction strategies, multilead monitoring, and reduced lead sets for monitoring-derived 12-lead ECGs with a minimal number of electrodes. 2,3 Despite these advances in technology, the need for human oversight in the interpretation of ECG monitoring data is as important today as it was 40 years ago for the following reasons. First, cardiac monitor algorithms are intentionally set for high sensitivity at the expense of specificity. As a result, numerous false alarms occur that must be evaluated by healthcare professionals so that overtreatment of patients will not occur. Examples of overtreatment are reported in the The American Heart Association makes every effort to avoid any actual or potential co...

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Cardiac Ischemia During Weaning From Mechanical Ventilation

Cited by 117 publications

References 16 publications

Noninvasive Monitoring of Cardiac Output During Weaning From Mechanical Ventilation: A Pilot Study

Noninvasive Monitoring of Cardiac Output During Weaning From Mechanical Ventilation: A Pilot Study

Weaning Failure of Cardiac Origin: Recent Advances

Practice Standards for ECG Monitoring in Hospital Settings: Executive Summary and Guide for Implementation

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