The Utility of Combined Chest and Cardiac Ultrasound in Management of Difficult –to – Wean COPD Patients
Marwa Sayed Daif Alsayed Daif;
Abstract
ABSTRACT
Background: The pathophysiology of weaning failure of COPD patients is most often complex and multifactorial. Lung dysfunction, cardiac dysfunction, and diaphragm dysfunction might contribute either alone or in combination to weaning failure. This work aims to assess the utility of integrated chest and basic cardiac ultrasound in management of difficult –to – wean COPD patients.
Methods: This prospectively cross sectional study was conducted upon 31 difficult-to-wean mechanically ventilated COPD patients in Respiratory ICUs of Ain Shams University Hospitals Patients clinically judged by the treating physician to be ready for weaning underwent a spontaneous breath trial (SBT) using T-piece. Combined thoracic and cardiac ultrasound was performed at the end of successful trial or with the commencement of signs of SBT failure.
Results: In Our study, a statistically significant relation between the presence ischemic heart diseases , elevated right ventricle systolic pressure (RVSP), low ejection fraction% (EF%) , evidence of left ventricular diastolic dysfunction, development of B lines, and decreased diaphragmatic thickness index and SBT outcome.
In patients with failed SBT elevated RVSP was the most frequent finding (69%), followed by left ventricular diastolic dysfunction (61.5%), low EF% (38%), B lines (61.5%), and diaphragmatic thickness index < 20% (19.3%). Combined B lines and diastolic dysfunction at end of SBT was the most frequent finding associated with failed SBT. The lung ultrasound findings were interpreted as indicative of interstitial oedema and SBT failure was attributed to increased left ventricular pressure and a diuretic therapy with or without vasodilators was recommended. The presence of consolidation, pleural effusion, and decreased diaphragmatic thickness index were poor predictors of SBT trial failure in our COPD patients
Conclusions: Concomitant assessment of cardiac, lung, and diaphragm functions by ultrasonography is a helpful tool in monitoring of SBT and in determining the most likely cause of failure.
Background: The pathophysiology of weaning failure of COPD patients is most often complex and multifactorial. Lung dysfunction, cardiac dysfunction, and diaphragm dysfunction might contribute either alone or in combination to weaning failure. This work aims to assess the utility of integrated chest and basic cardiac ultrasound in management of difficult –to – wean COPD patients.
Methods: This prospectively cross sectional study was conducted upon 31 difficult-to-wean mechanically ventilated COPD patients in Respiratory ICUs of Ain Shams University Hospitals Patients clinically judged by the treating physician to be ready for weaning underwent a spontaneous breath trial (SBT) using T-piece. Combined thoracic and cardiac ultrasound was performed at the end of successful trial or with the commencement of signs of SBT failure.
Results: In Our study, a statistically significant relation between the presence ischemic heart diseases , elevated right ventricle systolic pressure (RVSP), low ejection fraction% (EF%) , evidence of left ventricular diastolic dysfunction, development of B lines, and decreased diaphragmatic thickness index and SBT outcome.
In patients with failed SBT elevated RVSP was the most frequent finding (69%), followed by left ventricular diastolic dysfunction (61.5%), low EF% (38%), B lines (61.5%), and diaphragmatic thickness index < 20% (19.3%). Combined B lines and diastolic dysfunction at end of SBT was the most frequent finding associated with failed SBT. The lung ultrasound findings were interpreted as indicative of interstitial oedema and SBT failure was attributed to increased left ventricular pressure and a diuretic therapy with or without vasodilators was recommended. The presence of consolidation, pleural effusion, and decreased diaphragmatic thickness index were poor predictors of SBT trial failure in our COPD patients
Conclusions: Concomitant assessment of cardiac, lung, and diaphragm functions by ultrasonography is a helpful tool in monitoring of SBT and in determining the most likely cause of failure.
Other data
| Title | The Utility of Combined Chest and Cardiac Ultrasound in Management of Difficult –to – Wean COPD Patients | Authors | Marwa Sayed Daif Alsayed Daif | Issue Date | 2018 |
Recommend this item
Similar Items from Core Recommender Database
Items in Ain Shams Scholar are protected by copyright, with all rights reserved, unless otherwise indicated.