Weaning the cardiac patient from mechanical ventilation

Current Opinion in Critical Care

Volumn 20, Issue 5, 2014, Pages 493-498

  Dres, Martin ^a,b   Teboul, Jean Louis ^a,b   Monnet, Xavier ^a,b  

^a BICÊTRE HOSPITAL   (France)

^b UNIVERSITÉ PARIS SACLAY   (France)

Author keywords

Cardiac failure; Mechanical ventilation weaning; Pulmonary edema; Weaning

Indexed keywords

AMINO TERMINAL PRO BRAIN NATRIURETIC PEPTIDE; BRAIN NATRIURETIC PEPTIDE; CALCIUM CHANNEL BLOCKING AGENT; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; DOBUTAMINE; GLYCERYL TRINITRATE; HEMOGLOBIN; INOTROPIC AGENT; LEVOSIMENDAN; PLASMA PROTEIN;

ANGIOPLASTY; ARTIFICIAL VENTILATION; BREATHING; CARDIAC PATIENT; ECHOCARDIOGRAPHY; GOLD STANDARD; HEART FAILURE; HEART FUNCTION; HEART LEFT VENTRICLE FILLING PRESSURE; HEART MUSCLE ISCHEMIA; HEMOCONCENTRATION; HEMOGLOBIN DETERMINATION; HUMAN; LEFT VENTRICULAR DIASTOLIC DYSFUNCTION; LUNG EDEMA; LUNG EXTRAVASCULAR FLUID; NEGATIVE PRESSURE VENTILATION; POSITIVE END EXPIRATORY PRESSURE; PULMONARY ARTERY CATHETER; REVIEW; THERMODILUTION; WEANING; ADVERSE EFFECTS; COMPLICATION; HEMODYNAMICS; INTENSIVE CARE UNIT; METABOLISM; PATHOPHYSIOLOGY; PRACTICE GUIDELINE; PREDICTIVE VALUE; PROCEDURES; PULMONARY ARTERY CATHETERIZATION; PULMONARY EDEMA; RISK ASSESSMENT;

CATHETERIZATION, SWAN-GANZ; ECHOCARDIOGRAPHY; HEART FAILURE; HEMODYNAMICS; HUMANS; INTENSIVE CARE UNITS; NATRIURETIC PEPTIDE, BRAIN; PRACTICE GUIDELINES AS TOPIC; PREDICTIVE VALUE OF TESTS; PULMONARY EDEMA; RESPIRATION, ARTIFICIAL; RISK ASSESSMENT; VENTILATOR WEANING;

EID: 84925867627     PISSN: 10705295     EISSN: 15317072     Source Type: Journal    
DOI: 10.1097/MCC.0000000000000131     Document Type: Review

References (13)

1. Thille AW, Cortés-Puch I, Esteban A. Weaning from the ventilator and extubation in ICU. Curr Opin Crit Care 2013;19:57-64.
2. Teboul J-L, Monnet X, Richard C. Weaning failure of cardiac origin: recent advances. Crit Care 2010;14:211.
3. Teboul JL. Weaning-induced cardiac dysfunction: where are we today? Intensive Care Med 2014;40:1069-1079. This review article recalls the seminal study by Lemaire et al. (Anesthesiology, 1988), which clearly evidenced weaning-induced pulmonary edema. It is also an extensive and comprehensive review on the current knowledge in this field.
4. Gerbaud E, Erickson M, Grenouillet-Delacre M, et al. Echocardiographic evaluation and N-terminal pro-brain natriuretic peptide measurement of patients hospitalized for heart failure during weaning from mechanical ventilation. Minerva Anestesiol 2012;78:415-425. This manuscript is the most recently published concerning the diagnosis of weaning-induced cardiac failure with BNP and NT-proBNP.
5. Moschietto S, Doyen D, Grech L, et al. Transthoracic echocardiography with Doppler tissue imaging predicts weaning failure from mechanical ventilation: evolution of the left ventricle relaxation rate during a spontaneous breathing trial is the key factor in weaning outcome. Crit Care 2012;16:R81. This is the most recent publication emphasizing the important role of diastolic LV dysfunction in the genesis of weaning-induced cardiac failure. It interestingly shows that weaning failure is associated with the inability of the diastolic function to improve during the SBT.
6. Thille AW, Richard J-CM, Brochard L. The decision to extubate in the intensive care unit. Am J Respir Crit Care Med 2013;187:1294-1302. This is a recent and complete review concerning weaning from mechanical ventilation.
7. Dres M, Teboul J-L, Anguel N, et al. Extravascular lung water, B-type natriuretic peptide, and blood volume contraction enable diagnosis of weaning-induced pulmonary edema. Crit Care Med 2014;42:1882-1889. This original study confirms that changes in BNP levels and increases in plasma protein and hemoglobin concentrations are reliable alternatives to the pulmonary artery catheter for the diagnosis of weaning-induced pulmonary edema. This is also the first study showing that a direct measurement of extravascular lung water with transpulmonary thermodilution is a reliable diagnostic method.
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