Critical Care Research and Practice · 2019 · 17 citations · 27 references
Health ProfessionsCardiologyPharmacotherapyCardiothoracic SurgeryCardiovascular PharmacotherapyVentilator ManagementHeart FailureMechanical VentilationSpontaneous Breathing TrialsVentilator WeaningVentilatory SupportWeaning From Mechanical VentilationIntracardiac EchocardiographyLeft Ventricular PhysiologyLevosimendan TherapyMechanical Ventilation Weaning AssessmentSpontaneous Breathing Trial DurationVentricular Ejection Fraction AssessmentWeaning From Invasive Mechanical VentilationWeaning Parameters
Purpose . Mechanically ventilated patients with left ventricular (LV) dysfunction are at risk of weaning failure. We hypothesized that optimization of cardiovascular function might facilitate the weaning process. Therefore, we investigated the efficacy of levosimendan in difficult-to-wean patients with impaired LV performance. Materials and Methods . Nineteen mechanically ventilated patients, with LV ejection fraction (LVEF) 34 ± 8%, difficult-to-wean from the ventilator, were assessed by transthoracic echocardiography before the start and at the end of a spontaneous breathing trial (SBT) (first SBT). Eight patients successfully weaned. The remaining 11 failed-to-wean patients received a 24-hour infusion of levosimendan, and they were reassessed during a second SBT. Results . After levosimendan administration, LVEF increased from 30 ± 10 to 36 ± 3% (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mrow><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.01</mml:mn></mml:mrow></mml:math>). End-SBT peak e ′ velocity increased from 7 to 9 cm/s (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mrow><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.02</mml:mn></mml:mrow></mml:math>). E/e ′ increased from 10.5 to 12.9 during the first SBT, whereas it remained constant at 10 throughout the second SBT (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mrow><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.01</mml:mn></mml:mrow></mml:math>). During the second SBT, partial pressure of arterial oxygen and central venous oxygen saturation improved, compared to the first one (93 ± 34 vs. 67 ± 28 mmHg,<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mrow><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.03</mml:mn></mml:mrow></mml:math>, and 66 ± 11% vs. 57 ± 9%,<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mrow><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.02</mml:mn></mml:mrow></mml:math>, respectively). Nine of the 11 patients were successfully weaned from the ventilator. Conclusions . In difficult-to-wean from mechanical ventilation patients with LV dysfunction, levosimendan might contribute to successful weaning by improving both systolic and diastolic LV function.
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