Using Echocardiography and Chest Ultrasound for Guidance of Management of difficult to wean COPD patients
Dr Marwa Sayed Daif; Magdy M Khalil; Hala M Salem; Ayman Morttada Abd El Moteleb; Hossam-El Din M Abd-Elhamid;
Abstract
Abstract
Background: The Pathophysiology of mechanical ventilation weaning failure in COPD patients is often complex and Multifactorial. Cardiac dysfunction, Lung dysfunction and diaphragm dysfunction might contribute either alone or in combination to that condition. This work aims to assess the utility of integrated basic echocardiography and chest 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; who were clinically judged by the treating physician to be ready for weaning; underwent a spontaneous breath trial (SBT) using T-piece. Combined echocardiography study and thoracic ultrasound were performed at the end of successful trial or with the beginning of signs of SBT failure.
Results: There was 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, 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 (62%), low EF% (38%), B lines (62%), and diaphragmatic thickness index < 20% (25%). 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 edema 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 ultrasonography assessment of cardiac, lung, and diaphragm functions is a helpful tool in monitoring of SBT and in determining the most likely cause of failure. This may help guidance of weaning in such cases.
Keywords: Weaning failure, spontaneous breathing trial (SBT), combined chest and basic cardiac ultrasound
Background: The Pathophysiology of mechanical ventilation weaning failure in COPD patients is often complex and Multifactorial. Cardiac dysfunction, Lung dysfunction and diaphragm dysfunction might contribute either alone or in combination to that condition. This work aims to assess the utility of integrated basic echocardiography and chest 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; who were clinically judged by the treating physician to be ready for weaning; underwent a spontaneous breath trial (SBT) using T-piece. Combined echocardiography study and thoracic ultrasound were performed at the end of successful trial or with the beginning of signs of SBT failure.
Results: There was 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, 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 (62%), low EF% (38%), B lines (62%), and diaphragmatic thickness index < 20% (25%). 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 edema 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 ultrasonography assessment of cardiac, lung, and diaphragm functions is a helpful tool in monitoring of SBT and in determining the most likely cause of failure. This may help guidance of weaning in such cases.
Keywords: Weaning failure, spontaneous breathing trial (SBT), combined chest and basic cardiac ultrasound
Other data
| Title | Using Echocardiography and Chest Ultrasound for Guidance of Management of difficult to wean COPD patients | Authors | Dr Marwa Sayed Daif ; Magdy M Khalil; Hala M Salem; Ayman Morttada Abd El Moteleb; Hossam-El Din M Abd-Elhamid | Keywords | Weaning failure;spontaneous breathing trial (SBT);combined chest;basic cardiac ultrasound | Issue Date | 7-Aug-1018 | Publisher | Ayman Morttada Abd El Moteleb, Department of Cardiology Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt | Journal | Cardiology & Current Research | Volume | 11 | Issue | 4 | Description | Introduction Weaning of mechanical ventilation; in most patients; can be done; as soon as; the underlying reason for acute respiratory failure has been resolved. 20% to 30% of patients are considered difficult to wean from mechanical ventilation Weaning failure is defined as the failure to pass a spontaneous-breathing trial or the need for re-intubation within 48 hours following extubation.1 COPD (chronic obstructive pulmonary disease) is frequently associated with cardiac comorbidity and diaphragmatic dysfunction. Transthoracic echocardiography (TTE) was found useful to detect spontaneous breathing trial (SBT)-induced changes in central hemodynamics.2 Elevated left ventricular end diastolic pressure during weaning may induce pulmonary and bronchial wall edema which increases the work of breathing.3 Another factor is myocardial ischemia which may occur in response to increased respiratory workload, resulting spontaneous breathing trial failure.4 When performed by an experienced operator prior to SBT, TTE may help in identifying patients at high risk of cardiac-related weaning failure. Thoracic Ultrasound is also an important tool in revealing pulmonary pathologies that might delay weaning of mechanically ventilated COPD patients e.g. consolidation, collapse, pleural effusion, pneumothorax, diaphragmatic dysfunction. Previous studies focused on isolated organ contribution to weaning failure ignoring interaction between organs and multifactorial etiology of outcome of this rather complex issue. The aim of this work was to study the utility of integrated ultrasonographic information in defining the most probable cause(s) of weaning failure in the individual COPD patient. |
DOI | DOI: 10.15406/jccr.2018.11.00394 |
Attached Files
| File | Description | Size | Format | Existing users please Login |
|---|---|---|---|---|
| رساله الدكتوراه.pdf | 1.02 MB | Adobe PDF | Request a copy |
Similar Items from Core Recommender Database
Items in Ain Shams Scholar are protected by copyright, with all rights reserved, unless otherwise indicated.