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Groenland CNL, Blijleven MA, Ramzi I, Dubois EA, Heunks L, Endeman H, Wils EJ, Baggen VJM. The Value of Ischemic Cardiac Biomarkers to Predict Spontaneous Breathing Trial or Extubation Failure: A Systematic Review. J Clin Med 2024; 13:3242. [PMID: 38892952 PMCID: PMC11173145 DOI: 10.3390/jcm13113242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Background: It is unclear whether other cardiac biomarkers than NT-proBNP can be useful in the risk stratification of patients weaning from mechanical ventilation. The aim of this study is to summarize the role of ischemic cardiac biomarkers in predicting spontaneous breathing trial (SBT) or extubation failure. Methods: We systematically searched Embase, MEDLINE, Web of Science, and Cochrane Central for studies published before January 2024 that reported the association between ischemic cardiac biomarkers and SBT or extubation failure. Data were extracted using a standardized form and methodological assessment was performed using the QUIPS tool. Results: Seven observational studies investigating four ischemic cardiac biomarkers (Troponin-T, Troponin-I, CK-MB, Myoglobin) were included. One study reported a higher peak Troponin-I in patients with extubation failure compared to extubation success (50 ng/L [IQR, 20-215] versus 30 ng/L [IQR, 10-86], p = 0.01). A second study found that Troponin-I measured before the SBT was higher in patients with SBT failure in comparison to patients with SBT success (100 ± 80 ng/L versus 70 ± 130 ng/L, p = 0.03). A third study reported a higher CK-MB measured at the end of the SBT in patients with weaning failure (SBT or extubation failure) in comparison to weaning success (8.77 ± 20.5 ng/mL versus 1.52 ± 1.42 ng/mL, p = 0.047). Troponin-T and Myoglobin as well as Troponin-I and CK-MB measured at other time points were not found to be related to SBT or extubation failure. However, most studies were underpowered and with high risk of bias. Conclusions: The association with SBT or extubation failure is limited for Troponin-I and CK-MB and appears absent for Troponin-T and Myoglobin, but available studies are hampered by significant methodological drawbacks. To more definitively determine the role of ischemic cardiac biomarkers, future studies should prioritize larger sample sizes, including patients at risk of cardiac disease, using stringent SBTs and structured timing of laboratory measurements before and after SBT.
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Affiliation(s)
- Carline N. L. Groenland
- Department of Intensive Care, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (M.A.B.); (I.R.); (E.A.D.); (L.H.); (H.E.); (V.J.M.B.)
| | - Maud A. Blijleven
- Department of Intensive Care, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (M.A.B.); (I.R.); (E.A.D.); (L.H.); (H.E.); (V.J.M.B.)
| | - Imane Ramzi
- Department of Intensive Care, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (M.A.B.); (I.R.); (E.A.D.); (L.H.); (H.E.); (V.J.M.B.)
| | - Eric A. Dubois
- Department of Intensive Care, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (M.A.B.); (I.R.); (E.A.D.); (L.H.); (H.E.); (V.J.M.B.)
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Leo Heunks
- Department of Intensive Care, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (M.A.B.); (I.R.); (E.A.D.); (L.H.); (H.E.); (V.J.M.B.)
- Department of Intensive Care, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Henrik Endeman
- Department of Intensive Care, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (M.A.B.); (I.R.); (E.A.D.); (L.H.); (H.E.); (V.J.M.B.)
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland Ziekenhuis, 3045 PM Rotterdam, The Netherlands;
| | - Vivan J. M. Baggen
- Department of Intensive Care, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (M.A.B.); (I.R.); (E.A.D.); (L.H.); (H.E.); (V.J.M.B.)
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, 3015 GD Rotterdam, The Netherlands
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Zheng Y, Luo Z, Cao Z. NT-proBNP change is useful for predicting weaning failure from invasive mechanical ventilation among postsurgical patients: a retrospective, observational cohort study. BMC Anesthesiol 2023; 23:84. [PMID: 36941556 PMCID: PMC10026466 DOI: 10.1186/s12871-023-02039-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/10/2023] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND To evaluate the predictive value of N-terminal prohormone B-type natriuretic peptide (NTproBNP) for weaning failure among patients undergoing major surgeries during spontaneous breathing trial (SBT), compared to traditional weaning parameters. METHODS The observational cohort study retrospectively included postsurgical patients who received IMV and underwent a 2 h SBT. According to weaning outcome, NTproBNP level at initiation (NTproBNP1) and at end of 2 h SBT(NTproBNP2), the ΔNTproBNP%, RSBI and MV were compared between weaning failure and weaning success group. Multiple logistical regression and ROC curve were used to evaluate the capability of NTproBNP to predict weaning failure. RESULTS Out of the 323 included postsurgical patients, 45 (13.9%) patients had failed weaning. The ΔNTproBNP% was a better predictor for weaning failure (AUC 0.744;95%CI,0.693-0.791) than NTproBNP1(AUC 0.639; 95%CI,0.580-0.694)), NTproBNP2(AUC 0.742, 95%CI,0.688-0.792) and other traditional weaning index such as RSBI (AUC 0.651; 95%CI, 0.597-0.703) and MV (AUC 0.552; 95%CI,0.496-0.607). The cutoff value of ΔNTproBNP% for predicting weaning failure was 23.3% with the sensitivity75.76% and specificity73.38%. The multiple logistic regression analysis found that ΔNTproBNP%>23.3% was an independent predictor of weaning failure. CONCLUSION ΔNTproBNP% may be a useful marker for predict weaning failure for postsurgical patients, and it's better to be more careful to withdraw from invasive mechanical ventilation for those postsurgical patients with ΔNTproBNP% >23.3%. The corresponding interventions to optimize cardiac function should be actively given to these patients.
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Affiliation(s)
- Yingying Zheng
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zujin Luo
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhixin Cao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Cao J, Wang B, Zhu L, Song L. Pooled Analysis of Central Venous Pressure and Brain Natriuretic Peptide Levels in Patients With Extubation Failure. Front Physiol 2022; 13:858046. [PMID: 35910563 PMCID: PMC9335353 DOI: 10.3389/fphys.2022.858046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/09/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose: Cardiac insufficiency has been considered to be a common cause of extubation failure. Some studies have shown that central venous pressure (CVP) and brain natriuretic peptide (BNP) are able to predict extubation outcomes. Therefore, we conducted a pooled analysis to evaluate the potential of CVP and BNP levels as predictors of extubation outcomes, using a cohort of critically ill patients who were on mechanical ventilation (MV). Methods: We searched three online electronic databases up to October 2021. All data were analyzed using Review Manager 5.4. For each study, the analysis was performed using standardized mean differences (SMD) with 95% confidence intervals (CI). Results: The pooled analysis of seven studies on CVP levels and extubation outcomes showed that elevated CVP levels were significantly associated with extubation failure (SMD:0.47, 95% CI: 0. 43–0.51, p < 0.00001). This association also appeared before extubation (SMD:0.47, 95% CI: 0. 43–0.51, p < 0.00001), but it did not appear after extubation (SMD: 0.63, 95% CI: −0.05–1.31, p=0.07). Similarly, pooled analysis of eight studies on BNP levels and extubation outcomes showed that increased BNP levels are closely related to extubation failure (SMD:0.68, 95% CI: 0.49–0.86, p < 0.00001). This relationship also occurs before (SMD: 0.57, 95% CI: 0.35–0.79, p < 0.00001) and after (SMD: 0.91, 95% CI: 0.59–1.23, p < 0.00001) extubation. Conclusions: This study showed that elevated CVP and BNP levels are associated with extubation failure in critically ill patients. However, BNP levels are more valuable than CVP levels in predicting extubation outcomes.
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Affiliation(s)
- Jianghong Cao
- Department of Intensive Care Unit, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Beibei Wang
- Department of Cardiology, The First People's Hospital of Jinzhong, Jinzhong, China
| | - Lili Zhu
- Department of Intensive Care Unit, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Lu Song
- Department of Intensive Care Unit, Shanxi Provincial People's Hospital, Taiyuan, China
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4
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Zeid D, Ahmed W, Soliman R, Alazab A, Elsawy AS. Ultrasound-Guided Preload Indices during Different Weaning Protocols of Mechanically Ventilated Patients and its Impact on Weaning Induced Cardiac Dysfunction. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Elevation of the left ventricular (LV) filling pressure can occur during weaning of mechanical ventilation due to increase in LV preload and/or changes in LV compliance and LV afterload.
AIM: The aim of the study was to evaluate respiratory changes in internal jugular vein and inferior vena cava during weaning from mechanical ventilation.
METHODS: Prospective observational study conducted on 80 consecutive patients. Patients were divided randomly into two groups who met the readiness criteria to start spontaneous breathing trial (SBT) either on pressure support ventilation (PS/CPAP) for 30 min or T-piece for 120 min. Weaning failure was defined as a failed SBT or reintubation within 48 h. Echocardiographic evaluation was done on assisted controlled ventilation and at the end of SBT for preload assessment.
RESULTS: Mitral Septal E/E’ Cutoff value ≥6.1 with sensitivity 81% and specificity 84.2%, and AUC 0.73 for predicting weaning failure. IVC distensibility index on CPAP cutoff value ≥66.5% with sensitivity 100% and specificity 68.4%, and AUC 0.85. In Group II, Mitral Septal E/E’ Cut off value ≥5.8 with sensitivity 83% and specificity 90.9%, AUC 0.83, IVC collapsibility index Cut off value ≥45.5% with sensitivity 72% and specificity 86%, AUC 0.73.
CONCLUSION: Mitral Septal E/E’ could predict weaning-induced diastolic dysfunction. IVC plays an important role in predicting weaning failure.
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Wu ZH, Tang Y, Zhao M, Yu H, Li HD. Association between elevated brain natriuretic peptide levels and weaning failure: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e14850. [PMID: 34516015 DOI: 10.1111/ijcp.14850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Cardiovascular dysfunction has been reported as an important mechanism of weaning failure, and recent data suggest that elevated brain natriuretic peptide (BNP) levels is associated with an increased risk of weaning failure. Therefore, we performed this meta-analysis to evaluate the correlation between elevated BNP levels and weaning failure in critically ill patients subject to mechanical ventilation. METHODS A systematic search in Cochrane Library, Embase, PubMed and Web of Science was performed up to September 25, 2019. Standard mean differences (SMD) and corresponding 95% confidence intervals (CIs) of the BNP levels were calculated for each study. RESULTS Nine studies with a total number of 589 were included in the final meta-analysis. The results showed that elevated BNP levels were significantly associated with the risk of weaning failure (SMD: 0.76, 95% CI: 0.47 to 1.05, P < .00001). The finding was consistent with the BNP measured before (SMD: 0.68, 95% CI: 0.26 to 1.11, P = .002) or at the end of spontaneous breathing trial (SBT) (SMD: 0.85, 95% CI: 0.52 to 1.18, P < .00001). CONCLUSIONS This meta-analysis showed that increased plasma BNP concentration was associated with weaning failure in ICU patients.
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Affiliation(s)
- Zeng-Hong Wu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Tang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meng Zhao
- School of Life Sciences, Westlake University, Hangzhou, China
- Institute of Biology, Westlake Institute for Advanced Study, Hangzhou, China
| | - Hong Yu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua-Dong Li
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Massolo AC, Clemente M, Patel N, Cantone GV, Toscano A, Ficial B, Landolfo F, Calzolari F, Capolupo I, Biban P, Dotta A. Could myocardial function be predictive of successful extubation in newborns and infants? Pediatr Pulmonol 2021; 56:1733-1738. [PMID: 33580748 DOI: 10.1002/ppul.25316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the relationship between cardiac function and extubation readiness in infants using speckle tracking echocardiography. WORKING HYPOTHESIS Cardiac function combined with established clinical parameters may better identify readiness for extubation. STUDY DESIGN Pilot prospective observational study. PATIENT SELECTION Mechanically ventilated infants were included. METHODOLOGY Cardiac function was assessed by echocardiography immediately before extubation. Systolic and diastolic function in the left (LV) and right ventricles (RV) were assessed by measurement of longitudinal strain (LS), and circumferential strain (CS) in the LV only. Pulmonary artery pressures were assessed using the velocity of tricuspid regurgitation jet (TR), septal position, and end-systolic eccentricity index (EI ES). Cases who extubated successfully (Group 1) were compared to cases who required reintubation (Group 2). RESULTS Twenty-five cases were included. LV CS and RV LS were significantly lower in those who required reintubation (Group 2) compared to those who were successfully extubated (Group 1) (LV CS, -21 (12)% vs. -33 (3)%, p = .001; RV LS -19 (2.7)% vs. -20 (2.5)%, p = .04). TR was absent in all cases. The septal shape was normal in 18 cases (72%), displaced to the left in 7 (28%) cases. No significant differences were found in LV EI ES between groups.
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Affiliation(s)
- Anna C Massolo
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Clemente
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, UK
| | - Giulia V Cantone
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Toscano
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Francesca Landolfo
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Flaminia Calzolari
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Irma Capolupo
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Biban
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Dotta
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Miller A, Peck M, Clark T, Conway H, Olusanya S, Fletcher N, Coleman N, Parulekar P, Aron J, Kirk-Bayley J, Wilkinson JN, Wong A, Stephens J, Rubino A, Attwood B, Walden A, Breen A, Waraich M, Nix C, Hayward S. FUSIC HD. Comprehensive haemodynamic assessment with ultrasound. J Intensive Care Soc 2021; 23:325-333. [DOI: 10.1177/17511437211010032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
FUSIC haemodynamics (HD) – the latest Focused Ultrasound in Intensive Care (FUSIC) module created by the Intensive Care Society (ICS) – describes a complete haemodynamic assessment with ultrasound based on ten key clinical questions: 1. Is stroke volume abnormal? 2. Is stroke volume responsive to fluid, vasopressors or inotropes? 3. Is the aorta abnormal? 4. Is the aortic valve, mitral valve or tricuspid valve severely abnormal? 5. Is there systolic anterior motion of the mitral valve? 6. Is there a regional wall motion abnormality? 7. Are there features of raised left atrial pressure? 8. Are there features of right ventricular impairment or raised pulmonary artery pressure? 9. Are there features of tamponade? 10. Is there venous congestion? FUSIC HD is the first system of its kind to interrogate major cardiac, arterial and venous structures to direct time-critical interventions in acutely unwell patients. This article explains the rationale for this accreditation, outlines the training pathway and summarises the ten clinical questions. Further details are included in an online supplementary appendix.
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Affiliation(s)
- Ashley Miller
- Department of Intensive Care, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Marcus Peck
- Department of Intensive Care, Frimley Park Hospital NHS Foundation Trust, Surrey, UK
| | - Tom Clark
- Department of Intensive Care, Royal Devon and Exeter NHS Foundation Trust, Devon, UK
| | - Hannah Conway
- Department of Intensive Care, Glenfield Hospital, Leicester, UK
| | - Segun Olusanya
- Department of Intensive Care, Barts Health NHS Trust, London, UK
| | - Nick Fletcher
- Department of Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Nick Coleman
- Department of Intensive Care, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Prashant Parulekar
- Department of Intensive Care, East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Jonathan Aron
- Department of Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Justin Kirk-Bayley
- Department of Intensive Care, Royal Surrey County Hospital NHS Foundation Trust, Surrey, UK
| | | | - Adrian Wong
- Department of Intensive Care, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Jennie Stephens
- Department of Intensive Care, Royal Cornwall Hospitals NHS Trust, Cornwall, UK
| | - Antonio Rubino
- Department of Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Ben Attwood
- Department of Intensive Care, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Andrew Walden
- Department of Intensive Care, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Andrew Breen
- Department of Intensive Care, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Manprit Waraich
- Department of Intensive Care, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Catherine Nix
- Department of Intensive Care, University Hospital Limerick, Dooradoyle, Limerick Ireland
| | - Simon Hayward
- Department of Intensive Care, Blackpool Victoria Hospital, Blackpool, UK
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Tavares CAM, Bailey MA, Girardi ACC. Biological Context Linking Hypertension and Higher Risk for COVID-19 Severity. Front Physiol 2020; 11:599729. [PMID: 33329052 PMCID: PMC7710931 DOI: 10.3389/fphys.2020.599729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/28/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), represents a public health crisis of major proportions. Advanced age, male gender, and the presence of comorbidities have emerged as risk factors for severe illness or death from COVID-19 in observation studies. Hypertension is one of the most common comorbidities in patients with COVID-19. Indeed, hypertension has been shown to be associated with increased risk for mortality, acute respiratory distress syndrome, need for intensive care unit admission, and disease progression in COVID-19 patients. However, up to the present time, the precise mechanisms of how hypertension may lead to the more severe manifestations of disease in patients with COVID-19 remains unknown. This review aims to present the biological plausibility linking hypertension and higher risk for COVID-19 severity. Emphasis is given to the role of the renin-angiotensin system and its inhibitors, given the crucial role that this system plays in both viral transmissibility and the pathophysiology of arterial hypertension. We also describe the importance of the immune system, which is dysregulated in hypertension and SARS-CoV-2 infection, and the potential involvement of the multifunctional enzyme dipeptidyl peptidase 4 (DPP4), that, in addition to the angiotensin-converting enzyme 2 (ACE2), may contribute to the SARS-CoV-2 entrance into target cells. The role of hemodynamic changes in hypertension that might aggravate myocardial injury in the setting of COVID-19, including endothelial dysfunction, arterial stiffness, and left ventricle hypertrophy, are also discussed.
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Affiliation(s)
- Caio A M Tavares
- Geriatric Cardiology Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Matthew A Bailey
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Adriana C C Girardi
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
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Sanfilippo F, Di Falco D, Noto A, Santonocito C, Morelli A, Bignami E, Scolletta S, Vieillard-Baron A, Astuto M. Association of weaning failure from mechanical ventilation with transthoracic echocardiography parameters: a systematic review and meta-analysis. Br J Anaesth 2020; 126:319-330. [PMID: 32988600 DOI: 10.1016/j.bja.2020.07.059] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/26/2020] [Accepted: 07/26/2020] [Indexed: 12/17/2022] Open
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.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, A.O.U. 'Policlinico-Vittorio Emanuele', Catania, Italy.
| | - Davide Di Falco
- School of Anaesthesia and Intensive Care, University Hospital 'G. Rodolico', University of Catania, Catania, Italy
| | - Alberto Noto
- Department of Anesthesia and Critical Care, A.O.U. Policlinico 'G. Martino', University of Messina, Messina, Italy
| | - Cristina Santonocito
- Department of Anesthesia and Intensive Care, A.O.U. 'Policlinico-Vittorio Emanuele', Catania, Italy
| | - Andrea Morelli
- Department of Internal Clinical, Anesthesiological and Cardiovascular Sciences, University of Rome, 'La Sapienza', Rome, Italy
| | - Elena Bignami
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sabino Scolletta
- Department of Urgency and Emergency, of Organ Transplantation, Anesthesia and Intensive Care, Siena University Hospital, Siena, Italy
| | - Antoine Vieillard-Baron
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne-Billancourt, France; INSERM, UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - Marinella Astuto
- Department of Anesthesia and Intensive Care, A.O.U. 'Policlinico-Vittorio Emanuele', Catania, Italy; School of Anaesthesia and Intensive Care, University Hospital 'G. Rodolico', University of Catania, Catania, Italy; Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy
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10
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Xu X, Wu R, Zhang YJ, Li HW, He XH, Wang SM. Value of Combination of Heart, Lung, and Diaphragm Ultrasound in Predicting Weaning Outcome of Mechanical Ventilation. Med Sci Monit 2020; 26:e924885. [PMID: 32769960 PMCID: PMC7433387 DOI: 10.12659/msm.924885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Postextubation distress is detrimental to the prognosis of critically ill patients with successful spontaneous breathing trial. The known risk factors of failed weaning are associated with the heart, lungs, and diaphragm. The aim of this study was to explore the role of a combined model including indicators of heart, lung, and diaphragm ultrasound in predicting the weaning outcome. Material/Methods Patients’ clinical data and ultrasonic features of heart, lungs, and diaphragm were recorded. Patients were included in either the failed weaning group (n=24) or the successful weaning group (n=81). The association of potential variables with the risk of weaning failure was determined using multivariate logistic regression analysis. The accuracy of potential indicators for predicting the weaning outcome were evaluated and a multiindicator combined model was established to improve the predictive accuracy. Results Brain natriuretic peptide (odds ratio [OR]=1.120, P=0.004), left-atrial pressure (LAP) (OR=1.333, P=0.005), lung ultrasound score (LUS) (OR=1.736, P=0.001), and hemidiaphragm dysfunction (OR=3.942, P=0.014) were associated with an increased risk of weaning failure. However, all of these indicators could not accurately predict the weaning outcome independently (all areas under the curve [AUCs] <0.9). The combination of LAP, LUS, and hemidiaphragm dysfunction showed the highest AUC (AUC=0.919). Conclusions The combined model including LAP, LUS, and hemidiaphragm dysfunction were the most accurate method for the prediction.
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Affiliation(s)
- Xia Xu
- Department of Ultrasound, Ordos Central Hospital, Ordos, Inner Mongolia, China (mainland)
| | - Rong Wu
- Department of Ultrasound, Ordos Central Hospital, Ordos, Inner Mongolia, China (mainland)
| | - Ya-Jiang Zhang
- Department of Cardiology, Ordos Central Hospital, Ordos, Inner Mongolia, China (mainland)
| | - Hui-Wen Li
- Department of Ultrasound, Ordos Central Hospital, Ordos, Inner Mongolia, China (mainland)
| | - Xiu-Hong He
- Department of Ultrasound, Ordos Central Hospital, Ordos, Inner Mongolia, China (mainland)
| | - Shu-Min Wang
- Department of Ultrasound, Ordos Central Hospital, Ordos, Inner Mongolia, China (mainland)
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Bedet A, Tomberli F, Prat G, Bailly P, Kouatchet A, Mortaza S, Vivier E, Rosselli S, Lipskaia L, Carteaux G, Razazi K, Mekontso Dessap A. Myocardial ischemia during ventilator weaning: a prospective multicenter cohort study. Crit Care 2019; 23:321. [PMID: 31533788 PMCID: PMC6751853 DOI: 10.1186/s13054-019-2601-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/06/2019] [Indexed: 12/21/2022] Open
Abstract
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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Affiliation(s)
- Alexandre Bedet
- Medical Intensive Care Unit, DHU A-TVB, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, F-94010, France.
- Mondor Institute of Biomedical Research, CARMAS Research Group, Paris Est Créteil University, Créteil, F-94010, France.
| | - Françoise Tomberli
- Surgical Intensive Care Unit, DHU A-TVB, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, F-94010, France
| | - Gwenael Prat
- Intensive Care Unit, Cavale Blanche, Brest Regional University Hospital, 29200, Brest, France
| | - Pierre Bailly
- Intensive Care Unit, Cavale Blanche, Brest Regional University Hospital, 29200, Brest, France
| | - Achille Kouatchet
- Medical Intensive Care Unit, Angers University Hospital, 49933, Angers, France
| | - Sater Mortaza
- Medical Intensive Care Unit, Angers University Hospital, 49933, Angers, France
| | - Emmanuel Vivier
- Intensive Care Unit, Saint-Joseph Saint-Luc Hospital, 69007, Lyon, France
| | - Sylvene Rosselli
- Intensive Care Unit, Saint-Joseph Saint-Luc Hospital, 69007, Lyon, France
| | - Larissa Lipskaia
- Medical Intensive Care Unit, DHU A-TVB, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, F-94010, France
- Mondor Institute of Biomedical Research, CARMAS Research Group, Paris Est Créteil University, Créteil, F-94010, France
| | - Guillaume Carteaux
- Medical Intensive Care Unit, DHU A-TVB, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, F-94010, France
- Mondor Institute of Biomedical Research, CARMAS Research Group, Paris Est Créteil University, Créteil, F-94010, France
| | - Keyvan Razazi
- Medical Intensive Care Unit, DHU A-TVB, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, F-94010, France
- Mondor Institute of Biomedical Research, CARMAS Research Group, Paris Est Créteil University, Créteil, F-94010, France
| | - Armand Mekontso Dessap
- Medical Intensive Care Unit, DHU A-TVB, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, F-94010, France
- Mondor Institute of Biomedical Research, CARMAS Research Group, Paris Est Créteil University, Créteil, F-94010, France
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12
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Contribution of Levosimendan in Weaning from Mechanical Ventilation in Patients with Left Ventricular Dysfunction: A Pilot Study. Crit Care Res Pract 2019; 2019:7169492. [PMID: 31428473 PMCID: PMC6681623 DOI: 10.1155/2019/7169492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/04/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose Mechanically ventilated patients with left ventricular (LV) dysfunction are at risk of weaning failure. We hypothesized that optimization of cardiovascular function might facilitate the weaning process. Therefore, we investigated the efficacy of levosimendan in difficult-to-wean patients with impaired LV performance. Materials and Methods Nineteen mechanically ventilated patients, with LV ejection fraction (LVEF) 34 ± 8%, difficult-to-wean from the ventilator, were assessed by transthoracic echocardiography before the start and at the end of a spontaneous breathing trial (SBT) (first SBT). Eight patients successfully weaned. The remaining 11 failed-to-wean patients received a 24-hour infusion of levosimendan, and they were reassessed during a second SBT. Results After levosimendan administration, LVEF increased from 30 ± 10 to 36 ± 3% (p=0.01). End-SBT peak e′ velocity increased from 7 to 9 cm/s (p=0.02). E/e′ increased from 10.5 to 12.9 during the first SBT, whereas it remained constant at 10 throughout the second SBT (p=0.01). During the second SBT, partial pressure of arterial oxygen and central venous oxygen saturation improved, compared to the first one (93 ± 34 vs. 67 ± 28 mmHg, p=0.03, and 66 ± 11% vs. 57 ± 9%, p=0.02, respectively). Nine of the 11 patients were successfully weaned from the ventilator. Conclusions In difficult-to-wean from mechanical ventilation patients with LV dysfunction, levosimendan might contribute to successful weaning by improving both systolic and diastolic LV function.
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Routsi C, Stanopoulos I, Kokkoris S, Sideris A, Zakynthinos S. Weaning failure of cardiovascular origin: how to suspect, detect and treat-a review of the literature. Ann Intensive Care 2019; 9:6. [PMID: 30627804 PMCID: PMC6326918 DOI: 10.1186/s13613-019-0481-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/02/2019] [Indexed: 01/09/2023] Open
Abstract
Among the multiple causes of weaning failure from mechanical ventilation, cardiovascular dysfunction is increasingly recognized as a quite frequent cause that can be treated successfully. In this review, we summarize the contemporary evidence of the most important clinical and diagnostic aspects of weaning failure of cardiovascular origin with special focus on treatment. Pathophysiological mechanisms are complex and mainly include increase in right and left ventricular preload and afterload and potentially induce myocardial ischemia. Patients at risk include those with preexisting cardiopulmonary disease either known or suspected. Clinically, cardiovascular etiology as a predominant cause or a contributor to weaning failure, though critical for early diagnosis and intervention, may be difficult to be recognized and distinguished from noncardiac causes suggesting the need of high suspicion. A cardiovascular diagnostic workup including bedside echocardiography, lung ultrasound, electrocardiogram and biomarkers of cardiovascular dysfunction or other adjunct techniques and, in selected cases, right heart catheterization and/or coronary angiography, should be obtained to confirm the diagnosis. Official clinical practice guidelines that address treatment of a confirmed weaning-induced cardiovascular dysfunction do not exist. As the etiologies of weaning-induced cardiovascular dysfunction are diverse, principles of management depend on the individual pathophysiological mechanisms, including preload optimization by fluid removal, guided by B-type natriuretic peptide measurement, nitrates administration in excessive afterload and/or myocardial ischemia, contractility improvement in severe systolic dysfunction as well as other rational treatment in specific indications in order to lead to successful weaning from mechanical ventilation.
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Affiliation(s)
- Christina Routsi
- First Department of Critical Care, Medical School, National and Kapodistrian University of Athens, “Evangelismos” Hospital, Ipsilantou 45-47, 10676 Athens, Greece
| | - Ioannis Stanopoulos
- Respiratory Failure Unit, Medical School, “G. Papanikolaou” Hospital, Aristotle University, Thessaloníki, Greece
| | - Stelios Kokkoris
- First Department of Critical Care, Medical School, National and Kapodistrian University of Athens, “Evangelismos” Hospital, Ipsilantou 45-47, 10676 Athens, Greece
| | - Antonios Sideris
- Department of Cardiology, “Evangelismos” Hospital, Athens, Greece
| | - Spyros Zakynthinos
- First Department of Critical Care, Medical School, National and Kapodistrian University of Athens, “Evangelismos” Hospital, Ipsilantou 45-47, 10676 Athens, Greece
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Sanfilippo F, Scolletta S, Morelli A, Vieillard-Baron A. Practical approach to diastolic dysfunction in light of the new guidelines and clinical applications in the operating room and in the intensive care. Ann Intensive Care 2018; 8:100. [PMID: 30374644 PMCID: PMC6206316 DOI: 10.1186/s13613-018-0447-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/20/2018] [Indexed: 12/26/2022] Open
Abstract
There is growing evidence both in the perioperative period and in the field of intensive care (ICU) on the association between left ventricular diastolic dysfunction (LVDD) and worse outcomes in patients. The recent American Society of Echocardiography and European Association of Cardiovascular Imaging joint recommendations have tried to simplify the diagnosis and the grading of LVDD. However, both an often unknown pre-morbid LV diastolic function and the presence of several confounders-i.e., use of vasopressors, positive pressure ventilation, volume loading-make the proposed parameters difficult to interpret, especially in the ICU. Among the proposed parameters for diagnosis and grading of LVDD, the two tissue Doppler imaging-derived variables e' and E/e' seem most reliable. However, these are not devoid of limitations. In the present review, we aim at rationalizing the applicability of the recent recommendations to the perioperative and ICU areas, discussing the clinical meaning and echocardiographic findings of different grades of LVDD, describing the impact of LVDD on patients' outcomes and providing some hints on the management of patients with LVDD.
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Affiliation(s)
- F. Sanfilippo
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - S. Scolletta
- Unit of Intensive Care Medicine, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - A. Morelli
- Department of Anaesthesiology and Intensive Care, University of Rome, “La Sapienza”, Rome, Italy
| | - A. Vieillard-Baron
- Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne, France
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15
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Jaber S, Quintard H, Cinotti R, Asehnoune K, Arnal JM, Guitton C, Paugam-Burtz C, Abback P, Mekontso Dessap A, Lakhal K, Lasocki S, Plantefeve G, Claud B, Pottecher J, Corne P, Ichai C, Hajjej Z, Molinari N, Chanques G, Papazian L, Azoulay E, De Jong A. Risk factors and outcomes for airway failure versus non-airway failure in the intensive care unit: a multicenter observational study of 1514 extubation procedures. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:236. [PMID: 30243304 PMCID: PMC6151191 DOI: 10.1186/s13054-018-2150-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/07/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients liberated from invasive mechanical ventilation are at risk of extubation failure, including inability to breathe without a tracheal tube (airway failure) or without mechanical ventilation (non-airway failure). We sought to identify respective risk factors for airway failure and non-airway failure following extubation. METHODS The primary endpoint of this prospective, observational, multicenter study in 26 intensive care units was extubation failure, defined as need for reintubation within 48 h following extubation. A multinomial logistic regression model was used to identify risk factors for airway failure and non-airway failure. RESULTS Between 1 December 2013 and 1 May 2015, 1514 patients undergoing extubation were enrolled. The extubation-failure rate was 10.4% (157/1514), including 70/157 (45%) airway failures, 78/157 (50%) non-airway failures, and 9/157 (5%) mixed airway and non-airway failures. By multivariable analysis, risk factors for extubation failure were either common to airway failure and non-airway failure: intubation for coma (OR 4.979 (2.797-8.864), P < 0.0001 and OR 2.067 (1.217-3.510), P = 0.003, respectively, intubation for acute respiratory failure (OR 3.395 (1.877-6.138), P < 0.0001 and OR 2.067 (1.217-3.510), P = 0.007, respectively, absence of strong cough (OR 1.876 (1.047-3.362), P = 0.03 and OR 3.240 (1.786-5.879), P = 0.0001, respectively, or specific to each specific mechanism: female gender (OR 2.024 (1.187-3.450), P = 0.01), length of ventilation > 8 days (OR 1.956 (1.087-3.518), P = 0.025), copious secretions (OR 4.066 (2.268-7.292), P < 0.0001) were specific to airway failure, whereas non-obese status (OR 2.153 (1.052-4.408), P = 0.036) and sequential organ failure assessment (SOFA) score ≥ 8 (OR 1.848 (1.100-3.105), P = 0.02) were specific to non-airway failure. Both airway failure and non-airway failure were associated with ICU mortality (20% and 22%, respectively, as compared to 6% in patients with extubation success, P < 0.0001). CONCLUSIONS Specific risk factors have been identified, allowing us to distinguish between risk of airway failure and non-airway failure. The two conditions will be managed differently, both for prevention and curative strategies. TRIAL REGISTRATION ClinicalTrials.gov, NCT 02450669 . Registered on 21 May 2015.
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Affiliation(s)
- Samir Jaber
- PhyMedExp, University of Montpellier, Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, cedex 5, France.
| | - Hervé Quintard
- Université Cote d'Azur, CNRS U7275, CHU de Nice, Service réanimation polyvalente et U 7275, IPMC, Nice, France
| | - Raphael Cinotti
- Intensive Care & Anesthesiology Department, University of Nantes, Hotel-Dieu Hospital, Nantes, France
| | - Karim Asehnoune
- Intensive Care & Anesthesiology Department, University of Nantes, Hotel-Dieu Hospital, Nantes, France
| | | | - Christophe Guitton
- Medical Intensive Care Unit, Hôtel-Dieu Teaching Hospital, Nantes, France
| | - Catherine Paugam-Burtz
- Intensive Care & Anesthesiology Department, Univ Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Beaujon, F-75018, Paris, France
| | - Paer Abback
- Intensive Care & Anesthesiology Department, Univ Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Beaujon, F-75018, Paris, France
| | - Armand Mekontso Dessap
- Service de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010, Créteil Cedex, France
| | - Karim Lakhal
- Intensive Care & Anesthesiology Department, University of Nantes, Laennec Nord Hospital, Nantes, France
| | - Sigismond Lasocki
- Département Anesthésie Réanimation, CHU Angers, 49933, Angers, Cedex 9, France
| | - Gaetan Plantefeve
- Medical-Surgical Intensive Care Unit, General Hospital Centre, Argenteuil, France
| | - Bernard Claud
- Medical-Surgical Intensive Care Unit, General Hospital Centre, Le Puy-en-Velay, France
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Pôle Anesthésie Réanimation Chirurgicale SAMU, Hôpital de Hautepierre, Service d'Anesthésie-Réanimation Chirurgicale, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Institut de Physiologie, Equipe d'Accueil EA3072 "Mitochondrie, stress oxydant et protection musculaire", Strasbourg, France
| | - Philippe Corne
- Medical Intensive Care Unit, Montpellier University Hospital, Montpellier, France
| | - Carole Ichai
- Université Cote d'Azur, CNRS U7275, CHU de Nice, Service réanimation polyvalente et U 7275, IPMC, Nice, France
| | - Zied Hajjej
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, cedex 5, France
| | - Nicolas Molinari
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Gerald Chanques
- PhyMedExp, University of Montpellier, Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, cedex 5, France
| | - Laurent Papazian
- APHM, URMITE UMR CNRS 7278, Hôpital Nord, Réanimation des Détresses Respiratoires et Infections Sévères, Aix-Marseille Univ, Marseille, France
| | - Elie Azoulay
- Medical Intensive Care Unit, University of Paris-Diderot, Saint Louis Hospital, Paris, France
| | - Audrey De Jong
- PhyMedExp, University of Montpellier, Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, cedex 5, France
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Gotur DB. Sepsis in a Panorama: What the Cardiovascular Physician Should Know. Methodist Debakey Cardiovasc J 2018; 14:89-100. [PMID: 29977465 PMCID: PMC6027712 DOI: 10.14797/mdcj-14-2-89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Sepsis accounts for an estimated 30 million cases and 6 million deaths globally each year. According to a multidisciplinary task force convened by the Society of Critical Care Medicine and European Society of Intensive Care Medicine, sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection. Sepsis is a medical emergency, so much so that the World Health Organization made it a global health priority. Since patients with cardiovascular diseases have unique risk factors for sepsis, prompt and accurate diagnosis is critical. In this regard, the sepsis-specific Sequential Organ Failure Assessment (SOFA) helps clinicians identify the organ dysfunction and predict outcomes. Sepsis management is grouped into specific interventions called bundles, and completion of each bundle element is time sensitive. The U.S. Centers for Medicaid and Medicare Services and some state-specific regulations have made compliance with these bundles reportable as a quality measure. The updated Surviving Sepsis Campaign Hour-1 bundle recommends that lactate measurement, blood cultures procurement, broad spectrum antibiotics administration, resuscitation with 30 mL/kg crystalloid, and vasopressor initiation for hypotension all be initiated within 1 hour of time zero, which is from the time of triage in the emergency department or from sepsis diagnosis. Septic shock is defined as hypotension with a mean arterial pressure less than 65 mm Hg, requiring vasopressors despite adequate fluid resuscitation and/or lactic acid levels above 2 mmol/L. Both fluid resuscitation and clinical re-evaluation with lactate measurement guide the fluid and vasopressor therapy. Specific guidelines exist for organ support that address mechanical ventilation, blood transfusions, vasopressor choices, and nutrition.
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17
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Greenstein YY, Mayo PH. Evaluation of Left Ventricular Diastolic Function by the Intensivist. Chest 2018; 153:723-732. [DOI: 10.1016/j.chest.2017.10.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/17/2017] [Accepted: 10/19/2017] [Indexed: 12/15/2022] Open
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18
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Roche-Campo F, Bedet A, Vivier E, Brochard L, Mekontso Dessap A. Cardiac function during weaning failure: the role of diastolic dysfunction. Ann Intensive Care 2018; 8:2. [PMID: 29330683 PMCID: PMC5768586 DOI: 10.1186/s13613-017-0348-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/26/2017] [Indexed: 12/16/2022] Open
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. Electronic supplementary material The online version of this article (10.1186/s13613-017-0348-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ferran Roche-Campo
- Service de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Servei de Medicina Intensiva, Hospital Verge de la Cinta, Tortosa, Tarragona, Spain
| | - Alexandre Bedet
- Service de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France. .,Groupe de Recherche Clinique CARMAS, Institut Mondor de Recherche Biomédicale, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010, Créteil, France.
| | - Emmanuel Vivier
- Service de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Service de Réanimation Polyvalente, Centre hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - Laurent Brochard
- Service de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Keenan Research Centre and Critical Care Department, St Michael's Hospital, Toronto, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Armand Mekontso Dessap
- Service de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Groupe de Recherche Clinique CARMAS, Institut Mondor de Recherche Biomédicale, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010, Créteil, France
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19
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Sanfilippo F, Corredor C, Arcadipane A, Landesberg G, Vieillard-Baron A, Cecconi M, Fletcher N. Tissue Doppler assessment of diastolic function and relationship with mortality in critically ill septic patients: a systematic review and meta-analysis. Br J Anaesth 2017; 119:583-594. [DOI: 10.1093/bja/aex254] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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