Cardiac function during weaning failure: the role of diastolic dysfunction

Roche-Campo, Ferran; Bedet, Alexandre; Vivier, Emmanuel; Brochard, Laurent; Mekontso Dessap, Armand

doi:10.1186/s13613-017-0348-4

Annals of Intensive Care

Table 1 Patient characteristics and echocardiographic variables just before the weaning process, according to weaning category (n = 67)

From: Cardiac function during weaning failure: the role of diastolic dysfunction

	All patients (n = 67)	Weaning		p
	All patients (n = 67)	Short (n = 49)	Prolonged (n = 18)	p
Patient characteristics
Age, year	64 (47–76)	61 (49–75)	69 (44–81)	0.50
Male sex	44 (66)	31 (63)	13 (72)	0.49
SAPS II at ICU admission	46 (34–53)	44 (34–58)	46 (34–50)	0.50
Comorbidities
Hypertension	33 (49)	23 (47)	10 (56)	0.52
Diabetes	17 (26)	9 (19)	8 (44)	0.05
Chronic obstructive pulmonary disease	17 (25)	13 (27)	4 (22)	> 0.99
History of ischemic heart disease	13 (19)	11 (22)	2 (11)	0.48
Atrial fibrillation	22 (33)	13 (27)	9 (50)	0.07
Reason for intubation				0.67
Coma	13 (19)	9 (18)	4 (22)
Septic shock	8 (12)	5 (10)	3 (17)
Cardiogenic pulmonary edema	17 (25)	14 (29)	3 (17)
Pneumonia	18 (27)	12 (25)	6 (33)
Cardiac arrest	4 (6)	4 (8)	0 (0)
Surgery	7 (10)	5 (10)	2 (11)
Events between ICU admission and inclusion
Septic shock	33 (49)	25 (51)	8 (44)	0.63
Ventilator-associated pneumonia	15 (22)	9 (18)	6 (33)	0.21
Acute respiratory distress syndrome	26 (39)	18 (37)	8 (44)	0.56
Use of neuromuscular blockers	11 (16)	9 (18)	2 (11)	0.71
Cumulative fluid balance before inclusion, mL	4322 (949–7898)	4322 (175–7253)	4228 (1757–17,957)	0.27
Duration of invasive MV before inclusion, days	3 (2–6)	3 (2–6)	5 (3–13)	0.08
Clinical and biological data at inclusion
SOFA score	4 (3–6)	4 (3–6)	5 (4–6)	0.25
Systolic arterial pressure, mmHg	129 (122–144)	132 (113–146)	127 (108–136)	0.44
Heart rate, beats/min	93 (82–105)	93 (83–106)	91 (79–104)	0.60
Respiratory rate, beats/min	25 (19–30)	23 (18–29)	29 (27–33)	0.06
RPP, beats/min·mmHg	12,500 (11,288–15,346)	12,576 (10,744–15,520)	12,423 (12,245–13,035)	> 0.99
Arterial blood gases
pH, units	7.44 (7.40–7.47)	7.44 (7.40–7.47)	7.44 (7.41–7.47)	0.77
PaO₂/FiO₂ ratio, mmHg	210 (182–270)	222 (188–277)	186 (153–226)	< 0.01
PaCO₂, mmHg	41 (35–46)	40 (35–46)	42 (37–49)	0.42
BNP, pg/ml	331 (114–602)	302 (108–588)	415 (114–842)	0.51
Protidemia, g/L	58 (51–66)	58 (54–66)	54 (49–66)	0.39
Creatinine, micromol/L	79 (57–101)	81 (59–98)	73 (55–107)	0.96
Randomization in the interventional group	34 (51)	25 (51)	9 (50)	0.94
Echocardiographic variables
LVEF, %	55 (40–60)	50 (37–60)	60 (50–62)	0.26
Cardiac index, L/min/m2	3.0 (2.2–3.6)	3.1 (2.3–3.6)	2.7 (2.1–3.7)	0.52
Systolic dysfunction
LVEF < 50%	25 (37)	21 (43)	4 (22)	0.12
Diastolic dysfunction ^a
LVEF ≥ 50% and BNP > 35 pg/mL and (E/e′ ratio ≥ 13 or e′ < 9)	11 (17)	4 (8)	7 (39)	0.01
Heart valve disease^b	23 (34)	14 (29)	9 (50)	0.10
RV/LV area ratio	0.6 (0.5–0.7)	0.6 (0.4–0.7)	0.6 (0.5–0.7)	0.67
Tricuspid annular plane systolic excursion, cm	1.9 (1.5–2.6)	2.1 (1.7–2.7)	1.5 (1.3–1.9)	0.03
Systolic pulmonary artery pressure, mmHg	38 (25–51)	37 (25–49)	46 (25–66)	0.16

SAPS Simplified Acute Physiologic Score, ICU intensive care unit, MV mechanical ventilation, SOFA sequential organ failure assessment, RPP product of heart rate and systolic arterial pressure, FiO₂ fraction of inspired oxygen, BNP B-type natriuretic peptide, LVEF left ventricle ejection fraction, E early diastolic velocity measured using Doppler transmitral flow, A late diastolic velocity measured using Doppler transmitral flow, e′ early peak diastolic velocity of mitral annulus, a′ late peak diastolic velocity of mitral annulus, RV right ventricular end-diastolic area, LV left ventricular end-diastolic area
^aDiastolic function could not be assessed in one patient for e′ and in two patients for E/e′ ratio
^bHeart valve disease is defined as a severe aortic or mitral regurgitation (grade III/IV). Data are presented as n (%) or median (1st quartile–3rd quartile)

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