Myocardial ischaemia and weaning failure: is angioplasty the heart of the problem?

Carrié, C.; Bui, Hoang Nam; Gerbaud, Édouard; Vargas, Frédéric; Hilbert, Gilles

doi:10.1007/s00134-011-2186-4

Cited by 7 publications

(6 citation statements)

References 7 publications

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“…The incidence of myocardial ischemia as a cause of weaning failure was very different among previous publications ranging from 6 to 50% [27][28][29]. In our cohort, 25% of WIPO patients had a history of ischemic heart disease; however, we did not report any significant changes in ECG either before or during SBT.…”

Section: Discussioncontrasting

confidence: 84%

Diagnostic accuracy of lung ultrasound in detecting weaning-induced pulmonary edema

Hamad¹,

Abdel-Moniem²,

Meshref³

et al. 2023

Egypt J Bronchol

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Background Weaning-induced pulmonary edema (WIPO) is one of the commonest causes of weaning failure in critical care. As ultrasound machine is an easy and available tool in critical care units that help to diagnose interstitial lung syndrome by detecting B lines, it can be a handy method for diagnosis of WIPO. Aim We aimed to detect the threshold of increase in B lines (ΔB lines) that can accurately diagnose WIPO. Methods This is a prospective observational study carried on 52 mechanically ventilated patients who were eligible for weaning. Lung ultrasound was done before and after spontaneous breathing trial (SBT) to detect the increase in B lines (ΔB lines). Results Among the first 52 SBT, 25 trials were failed. Twelve patients developed WIPO (23% of all SBT and 48% of failing SBT). The best diagnostic accuracy for WIPO was a ΔB lines ≥ 6. In these cases, a ΔB line ≥ 6 has a sensitivity of 83.3%, a specificity of 82.5%, a positive predictive value of 58.8%, and a negative predictive value of 94.3% (area under the curve = 0.824, p < 0.001). Low body mass index (BMI) and increased number of ΔB lines were independent predictors of WIPO. Conclusion A ΔB lines ≥ 6 has the best diagnostic accuracy for diagnosis of WIPO during SBT. Trial registration NCT04463303.

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Section: Discussioncontrasting

confidence: 84%

Diagnostic accuracy of lung ultrasound in detecting weaning-induced pulmonary edema

Hamad¹,

Abdel-Moniem²,

Meshref³

et al. 2023

Egypt J Bronchol

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“…Many of these previous studies had included a large proportion of patients with coronary artery disease. Although it has been reported that myocardial ischaemia could be the main mechanism of cardiac failure during weaning in some instances, and that its treatment may improve the weaning success in such cases [27], this mechanism is far from common.…”

Section: Discussionmentioning

confidence: 99%

Cardiac dysfunction induced by weaning from mechanical ventilation: incidence, risk factors, and effects of fluid removal

et al. 2016

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BackgroundWeaning-induced pulmonary oedema (WiPO) is a well-recognised cause of failure of weaning from mechanical ventilation, but its incidence and risk factors have not been reliably described. We wanted to determine the incidence and risk factors in a population of critically ill patients. In addition, we wanted to describe the effects of diuretics when they are administered in this context.MethodsWe monitored 283 consecutive spontaneous breathing trials (SBT; T-piece trial) performed in 81 patients. In cases with cardiac output monitoring (n = 85, 29 patients), a passive leg raising (PLR) test was performed before SBT. Three experts established the diagnosis of WiPO based on various patient characteristics.ResultsSBT failed in 128 cases (45 % of all SBT). WiPO occurred in 59 % of these failing cases. Compared to patients without WiPO (n = 52), patients with at least one WiPO (n = 29) had a higher prevalence of chronic obstructive pulmonary disease (COPD) (38 % vs. 12 %, respectively; p < 0.01), previous “structural” cardiopathy (dilated and/or hypertrophic and/or hypokinetic cardiopathy and/or significant valvular disease, 9 % vs. 25 %, respectively; p < 0.01), obesity (45 % vs. 17 %, respectively; p < 0.01), and low left ventricular ejection fraction (55 % vs. 21 %, respectively; p = 0.01). At logistic regression, COPD (odds ratio (OR) 8.7, 95 % confidence interval (CI) 2.0–37.3), previous structural cardiopathy (OR 4.5, 95 % CI 1.4–14.1), and obesity (OR 3.6, 95 % CI 1.2–12.6) were independent risk factors for experiencing at least one episode of WiPO. In 16 cases with WiPO and a negative PLR at baseline, treatment including diuretics was started. In 9 of these cases, the PLR remained negative before the following SBT. A new episode of WiPO occurred in 7 of these instances, while the two other were extubated. In 7 other cases, the PLR became positive before the following SBT. WiPO did not occur anymore in 6 of these 7 patients who were extubated, while the remaining one was not.ConclusionsIn our population of critically ill patients, WiPO was responsible for 59 % of weaning failures. COPD, previous “structural” cardiopathy, and, to a lesser extent, obesity were the main risk factors. When a treatment including fluid removal had changed preload-independence to preload-dependence, the following SBT was very likely to succeed.

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“…Only two patients with significant modifications of ST monitoring were treated for an acute coronary syndrome after the second SBT. Although quite infrequent, aggressive therapeutic interventions (such as coronary reperfusion) may sometimes be required to successfully extubate those patients [34, 35]. The pre-existence of a known coronary artery disease (before admission to ICU) was not associated with WiCI.…”

Section: Discussionmentioning

confidence: 99%

Myocardial ischemia during ventilator weaning: a prospective multicenter cohort study

et al. 2019

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Background Weaning-induced cardiac pulmonary edema (WiPO) is one of the main mechanisms of weaning failure during mechanical ventilation. We hypothesized that weaning-induced cardiac ischemia (WiCI) may contribute to weaning failure from cardiac origin. Methods A prospective cohort study of patients mechanically ventilated for at least 24 h who failed a first spontaneous breathing trial (SBT) was conducted in four intensive care units. Patients were explored during a second SBT using multiple tools (echocardiography, continuous 12-lead ST monitoring, biomarkers) to scrutinize the mechanisms of weaning failure. WiPO definition was based on three criteria (echocardiographic signs of increased left atrial pressure, increase in B-type natriuretic peptides, or increase in protein concentration during SBT) according to a conservative definition (at least two criteria) and a liberal definition (at least one criterion). WiCI was diagnosed according to the third universal definition of myocardial infarction proposed by the European Society of Cardiology (ESC) and the American Heart Association (AHA) statement for exercise testing. Results Among patients who failed a first SBT, WiPO occurred in 124/208 (59.6%) and 44/208 (21.2%) patients, according to the liberal and conservative definition, respectively. Among patients with ST monitoring, WiCI was diagnosed in 36/177 (20.3%) and 12/177 (6.8%) of them, according to the ESC and AHA definitions, respectively. WiCI was not associated with WiPO and was not associated with weaning outcomes. Only two patients of the cohort were treated for an acute coronary syndrome after the second SBT, and seven other patients required coronary angiography during the weaning period. Conclusions This observational study showed the common occurrence of pulmonary edema in mechanically ventilated patients who failed a first SBT, but the association with cardiac ischemia and weaning outcomes was weak.

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Myocardial ischaemia and weaning failure: is angioplasty the heart of the problem?

Cited by 7 publications

References 7 publications

Diagnostic accuracy of lung ultrasound in detecting weaning-induced pulmonary edema

Diagnostic accuracy of lung ultrasound in detecting weaning-induced pulmonary edema

Cardiac dysfunction induced by weaning from mechanical ventilation: incidence, risk factors, and effects of fluid removal

Myocardial ischemia during ventilator weaning: a prospective multicenter cohort study

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