Left ventricular diastolic dysfunction as a predictor of weaning failure from mechanical ventilation
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Left ventricular diastolic dysfunction as a predictor of weaning failure from mechanical ventilation Ajay Kumar Jha* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Dear Editor, I read an interesting article by Bouhemad et al. [1] in the recent issue of Intensive Care Medicine with great enthusiasm. The study could not find an additional predictive value of left ventricular diastolic dysfunction (LVDD) with high filling pressure on mechanical ventilation weaning in patients with antero-lateral lung ultrasound (LUS) score ≥ 5. However, an isolated LVDD has been consistently associated with weaning failure from mechanical ventilation and it has been found to worsen during spontaneous breathing trial (SBT) [2, 3]. The result of the study can be interpreted in several ways. First of all, all patients had a variable extent of diastolic dysfunction and 60% (24/40) of patients had high filling pressure on mechanical ventilation (MV). The prevalence of weaning or extubation failure in high filling pressure group was higher [(54.16% (13/24) vs 31.25% (5/16)] than the low filling pressure group irrespective of the LUS score. Decruitment or an increase in cardiac output during SBT may lead to transient or prolonged rise in filling pressure. Three patients in low filling pressure manifested echocardiographic signs of high filling pressure during SBT. Therefore, it would not be unreasonable to assume an exaggerated rise in filling pressure after SBT in those who already had higher filling pressure. A higher generalized lung loss due to decruitment may reduce the functional residual capacity (FRC) considerably. Low FRC induced increase in pulmonary vascular resistance may produce right ventricular volume overload, and the
*Correspondence: [email protected] Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
interventricular dependence would increase the LV filling pressure further [4]. The antero-lateral LUS scores during the mechanical ventilation were comparable, and unarguably, LVDD with high filling pressure yielded a higher prevalence of weaning or extubation failure. Furthermore, the incidence of LV filling pressure did not change during SBT in patients with LUS score
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