Table 1 Studies with cardiovascular agents that have been used in patients who are difficult-to-wean from mechanical ventilation
Study (References) | No. of patients | Study population diagnosis | Agent (class) | Indication given for | Effect | Main findings/comments |
|---|---|---|---|---|---|---|
Lemaire et al. [6] | 15 | COPD with concomitant cardiovascular disease | Furosemide (loop of Henle diuretic) | Increased preload/fluid management/Hypervolemia | Preload reduction | 9/15 patients were successfully weaned |
Aubier et al. [81] | 8 | COPD | Dopamine (catecholamine) 10 µg/kg | Impaired diaphragmatic function | Some vasopressor, increase splanchnic blood flow | Results of weaning outcome not reported |
Valtier et al. [21] | 6 | Coronary artery disease | Enoximone (phosphodiesterase -3 inhibitor) | LV dysfunction | Prevention of weaning-induced LV dysfunction | 5/6 patients were successfully weaned |
Paulus et al. [20] | 9 | LV failure after cardiac surgery | Enoximone (phosphodiesterase -3 inhibitor) 30 µg/kg/min followed by 10 µg/kg/min | LV failure | Increase in cardiac index, no change in PAOP | 7/9 patients were successfully weaned |
Duane et al. [99] | 1 | Trauma patient with coronary artery disease | Esmolol IV (beta-blockers) 500 µg followed by 50–100 µg/kg/min | Tachycardia, hypertension and pulmonary edema upon spontaneous breathing | Normal heart rate and systolic blood pressure | Successfully weaned |
Adamopoulos et al. [98] | 2 | Postoperative patients with hypertrophic obstructive cardiomyopathy | Atenolol 200 mg/day (beta-blockers) + Diltiazem 300 mg/day (calcium channel blocker) | hypertrophic obstructive cardiomyopathy | Decreased dynamic LV obstruction (induced by catecholamines), improved LV compliance | Successfully weaned |
Ng et al. [95] | 1 | Secondary pulmonary hypertension and RV dysfunction | Sildenafil (Phosphodiesterase-5 inhibitor) 12.5–25 mg 3 times/day | severe pulmonary hypertension | Decrease in PAP and PVR | Successfully weaned from INO and mechanical ventilation |
Stanopoulos et al. [19] | 3 | COPD | Sildenafil (Phosphodiesterase-5 inhibitor) 50 mg | Pulmonary hypertension | Decrease in PAP and PAOP | Successfully weaned |
Sterba et al. [17] | 12 | Patients with LVEF < 40% | Levosimendan (Calcium sensitizer) 0.108–0.21 μg/kg/min, loading dose 12 µg/kg in 6 patients | Impaired LVEF | Increase in LVEF | 7/12 successfully weaned |
Meaudre et al. [88] | 1 | Dilatated cardiomyopathy | Levosimendan (Calcium sensitizer) loading dose 12 µg/kg followed by 0.1 µg/kg/min × 24 h | Impaired LVEF High LV filling pressures | Increase in LVEF and a decrease in cardiac filling pressures | Successfully weaned |
Routsi et al. [18] | 12 | COPD exhibiting systemic arterial hypertension during SBT | Nitroglycerin (vasodilator) 40–600 µg/min | Increased LV afterload | Decrease in LV filling pressures and afterload | 10/12 patients successfully weaned |
Ouanes-Besbe et al. [83] | 10 | COPD and normal LVEF | Dobutamine (beta-agonist) 7µ/kg/min followed by Levosimendan (Calcium sensitizer) 0.2µ/kg/min × 24 h | PAOP increase ≥ 10 mmHg during SBT | PAOP and PAP increased to a lesser extent with Levosimendan than with Dobutamine | Successfully weaned Dobutamine increased the rate-pressure product (No indication according to guidelines [39],(see text) |
Elias et al. [94] | 1 | Interstitial lung disease, pulmonary hypertension | Sildenafil (Phosphodiesterase-5 inhibitor) 20–30 mg3 times/day | Severe pulmonary hypertension and a patent foramen ovale | Decrease in PAP | Successfully weaned from INO and mechanical ventilation |
Mekontso Dessap et al. [65]a | 304 | General ICU patients eligible for weaning. BNP-driven or physician-driven fluid management | Furosemide (loop of Henle diuretic) ± Acetazolamide sodium (carbonic anhydrase inhibitor) | Fluid overload | More negative fluid balance in BNP-guided group | Shorter duration of MV in BNP-guided approach. Strongest effect in patients with LV systolic dysfunction |
Cateano et al. [89] | 1 | Aortic stenosis, LV systolic dysfunction | Levosimendan (Calcium sensitizer) 0.1 µg/kg/min × 24 h | LV systolic dysfunction | LV systolic function and mean aortic gradient increased | Successfully weaned |
Mongodi et al. [56] | 1 | COPD, arterial hypertension, rheumatoid arthritis | Ramipril (angiotensin-converting enzyme inhibitors) 2.5 mg/die, Nebivolol (beta-blockers) 5 mg/die)and mild negative water balance | LV diastolic dysfunction, LUS consistent with increased EVLW | Reduced LV filling pressures and normal LUS | Successfully weaned |