Right heart function measured by ultrasonography for predication of withdrawal result in patients on mechanical ventilation

doi:10.3877/cma.j.issn.1672-6448.2021.09.011

Abstract

Abstract:

Objective

To assess the clinical value of right heart function measured by ultrasonography in predicting the withdrawal result in patients on mechanical ventilation.

Methods

One hundred patients on mechanical ventilation who were treated at the First Affiliated Hospital of Anhui Medical University from January 2018 to November 2020 were enrolled. T tube model was used to perform spontaneous breathing trial in these patients after machine withdrawal screening. The withdrawal result was observed, and ultrasonography was used to compare the right heart function indexes between withdrawal success and withdrawal failure groups. The area under the curve of each heart function index in predicting the withdrawal result was assessed.

Results

Of the 100 patients included, 78 had successful withdrawal and 22 had failed withdrawal, with a success rate of 78.0% (78/100). Before withdrawal, the central venous pressure was significantly higher in the failure group than in the success group [(10.1±2.9) mmHg vs (7.3±2.8) mmHg; t=7.871, P=0.002], while sex, age, acute physiology and chronic health evaluation Ⅱ score, heart rate, respiratory frequency, mean arterial pressure, central venous pressure, pressure of oxygen in arterial blood/fraction of inspired oxygen, and lactate concentration were comparable between the two groups (P＞0.05). Compared with the successful withdrawal group, systolic displacement of the tricuspid annulus and the ratio of the blood flow peak velocity in the early diastole to the blood flow peak velocity in the late diastole were significantly lower [(13.3±6.8) mm vs (25.2±6.4) mm, t=18.825, P=0.001; (1.0±0.4) vs (1.6±0.6), t=8.733, P=0.024], and right ventricular end diastolic area/left ventricular end diastolic area ratio and end expiratory inferior vena cava diameter were significantly higher [(0.9±0.1) vs (0.5±0.2), t=-9.221, P＜0.001; (19.0±4.8) mm vs (14.3±4.5) mm, t=-17.955, P=0.001 in the failure group. The cardiac ultrasound index TAPSE, mitral E/A, RVarea/LVarea, dIVC has predictive value for patient withdrawal results, with TAPSE (0.87) and mitral E/A (0.75) predicting large AUC of withdrawal results.

Conclusion

Right heart function assessed by ultrasonography can predict the withdrawal result and guide fluid management in patients on mechanical ventilation.

Key words: Mechanical ventilation, Ultrasonography, Withdrawal result, Right heart function, Prediction

Yuanyuan Tan, Zhenxing Ding, Dan Zhang, Feng Yu. Right heart function measured by ultrasonography for predication of withdrawal result in patients on mechanical ventilation[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(09): 875-879.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2021.09.011

https://chaosheng.cma-cmc.com.cn/EN/Y2021/V18/I09/875

Figures/Tables 5

组别	例数	年龄（岁， $x ¯$ ±s）	男/女（例）	APACHE Ⅱ评分（分， $x ¯$ ±s）	心率（次/min， $x ¯$ ±s）	呼吸频率（次/min， $x ¯$ ±s）	MAP（mmHg， $x ¯$ ±s）	CVP（mmHg， $x ¯$ ±s）	PaO₂/FiO₂（mmHg， $x ¯$ ±s）	乳酸浓度（mmol/L， $x ¯$ ±s）
撤机成功组	78	59.2±14.8	49/29	10.2±4.1	83.0±14.0	14.0±5.0	81.3±11.6	7.3±2.8	283.2±74.8	2.0±0.5
撤机失败组	22	60.1±14.9	14/8	11.1±4.9	87.0±15.0	16.0±6.0	80.7±11.0	10.1±2.9	279.1±75.2	2.0±0.6
统计值		t=0.558	χ²=0.063	t=0.282	t=0.313	t=0.378	t=0.118	t=7.871	t=1.167	t=1.003
P值		0.455	0.962	0.784	0.764	0.717	0.925	0.002	0.255	0.327

组别	例数	年龄（岁， $x ¯$ ±s）	男/女（例）	APACHE Ⅱ评分（分， $x ¯$ ±s）	心率（次/min， $x ¯$ ±s）	呼吸频率（次/min， $x ¯$ ±s）	MAP（mmHg， $x ¯$ ±s）	CVP（mmHg， $x ¯$ ±s）	PaO₂/FiO₂（mmHg， $x ¯$ ±s）	乳酸浓度（mmol/L， $x ¯$ ±s）
撤机成功组	78	59.2±14.8	49/29	10.2±4.1	83.0±14.0	14.0±5.0	81.3±11.6	7.3±2.8	283.2±74.8	2.0±0.5
撤机失败组	22	60.1±14.9	14/8	11.1±4.9	87.0±15.0	16.0±6.0	80.7±11.0	10.1±2.9	279.1±75.2	2.0±0.6
统计值		t=0.558	χ²=0.063	t=0.282	t=0.313	t=0.378	t=0.118	t=7.871	t=1.167	t=1.003
P值		0.455	0.962	0.784	0.764	0.717	0.925	0.002	0.255	0.327

组别	例数	TAPSE（mm）	三尖瓣 E/A	RVarea/LVarea	dIVC（mm）
撤机成功组	78	25.2±6.4	1.6±0.6	0.5±0.2	14.3±4.5
撤机失败组	22	13.3±6.8	1.0±0.4	0.9±0.1	19.0±4.8
t值		18.825	8.733	-9.221	-17.955
P值		0.001	0.024	＜0.001	0.001

超声检查指标	AUC	95%CI	P值	截断值	敏感度（%）	特异度（%）
TAPSE	0.87	0.81~0.96	0.01	15.0	94	78
三尖瓣E/A	0.75	0.67~0.89	0.01	1.0	82	78
RVarea/LVarea	0.73	0.63~0.88	0.01	0.7	75	80
dIVC	0.70	0.60~0.87	0.01	18.0	66	79

References 15

1	Mayo P, Volpicelli G, Lerolle N, et al. Ultrasonography evaluation during the weaning process:the heart, the diaphragm, the pleura and the lung [J]. Intensive Care Med, 2016, 42(7): 1107-1117.
2	Béduneau G, Pham T, Schortgen F, et al. Epidemiology of weaning outcome according to a new definition. The WIND study [J]. Am J Respir Crit Care Med, 2016, 195(6): 772-783.
3	王小亭, 刘大为, 于凯江, 等. 中国重症超声专家共识 [J]. 临床荟萃, 2017, 55(5): 369-383.
4	Routsi C, Stanopoulos I, Kokkoris SA, et al. Weaning failure of cardiovascular origin: how to suspect, detect and treat a review of the literature [J]. Ann Intensive Care, 2019, 9(1): 6.
5	Roche-Campo F, Bedet A, Vivier EA, et al. Cardiac function during weaning failure:the role of diastolic dysfunction [J]. Ann Intensive Care, 2018, 8(1): 2.
6	Vieillard-Baron A, Mayo P. Lung ultrasonography and echocardiography in the intensive care unit:a combined and practical approach [J]. Minerva Anestesiol, 2018, 84(3): 398-408.
7	de Meirelles Almeida CA, Nedel WL, Morais VD, et al. Diastolic dysfunction as a predictor of weaning failure:a systematic review and meta-analysis [J]. J Crit Care, 2016, 34: 135-141.
8	Liu J, Shen F, Teboul JL, et al. Cardiac dysfunction induced by weaning from mechanical ventilation:incidence, risk factors,and effects of fluid removal [J]. Critical Care, 2016, 20(1): 369.
9	Levitov A, Frankel HL, Blaivas MA, et al. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part Ⅱ:cardiac ultrasonography [J]. Crit Care Med, 2016, 44(6): 1206-1227.
10	Chiumello D, Brochard L, Marini JJ, et al. Respiratory support in patients with acute respiratory distress syndrome:an expert opinion [J]. Critical Care, 2017, 21(1): 240.
11	Venkatachalam S, Wu G, Ahmad M. Echocardiographic assessment of the right ventricle in the current era:application in clinical practice [J]. Echocardiography, 2017, 34(12): 1930-1947.
12	Thille AW, Boissier F, Ben Ghezala H, et al. Risk factors for and prediction by caregivers of extubation failure in ICU patients:a prospective study [J]. Crit Care Med, 2015, 43(3): 613-620.
13	Repesse X, Charron C, Vieillard-Baron A. Assessment of the effects of inspiratory load on right ventricular function [J]. Curr Opin Crit Care, 2016, 22(3): 254-259.
14	Pinsky MR. Cardiopulmonary interactions:physiologic basis and clinical applications [J]. Ann Am Thorac Soc, 2018, 15(1): S45-S48.
15	Repessé X, Vieillard-Baron A. Right heart function during acute respiratory distress syndrome [J]. Ann Transl Med, 2017, 5(14): 295.

[1]	Shujie Wei, Pinjing Hui, Yafang Ding, Bai Zhang, Yanhong Yan, Peng Zhou, Yabo Huang. Evaluation of cerebral hemodynamics in patients with unilateral internal carotid artery occlusion undergoing superficial temporal artery-middle cerebral artery bypass [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1046-1055.
[2]	Xuan Zhang, Yutong Ma, Yuqian Miao, Yun Zhang, Shiwen Wu, Xiaochu Dang, Yingying Chen, Zhaoming Zhong, Xuejuan Wang, Miao Hu, Yanfeng Sun, Xiuzhu Ma, Faqin Lyu, Haiyan Kou. Ultrasound assessment of diaphragm function in pediatric patients with Duchenne muscular dystrophy [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1068-1073.
[3]	Lianhua Zhu, Xiang Fei, Peng Han, Bo Jiang, Nan Li, Yukun Luo. Value of high frame rate contrast-enhanced ultrasound in differential diagnosis of gallbladder polyp lesions [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 904-910.
[4]	Meifang Zhang, Ying Tan, Qiaozhen Zhu, Xin Wen, Ying Yuan, Yue Qin, Hongbo Guo, Lingxiu Hou, Wenlan Huang, Guiyan Peng, Shengli Li. Artificial intelligence-based quality control of mid-sagittal plane ultrasound images for first trimester fetal crown-rump length [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 945-950.
[5]	Ruina Zhao, Yuxin Jiang, Tao Chen, Li Zhang, Cheng Chen, Siqi Jin, Xueqi Chen, Xiao Yang, Jianchu Li. Present status and reform demands of continuing medical education for ultrasonic physicians in Beijing [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 966-973.
[6]	Yuhan Zhou, Huan Xiao, Chunjiang Yang, Juan Zhou, Lirong Zhu, Juan Xu, Fangting Mou. Diagnostic value of ultrasound in children with temporary hip synovitis [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 795-800.
[7]	Huanyan Liu, Yang Hua, Lingyun Jia, Xinyu Zhao, Beibei Liu. Lumen structure and hemodynamic characteristics of occluded internal carotid artery [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 809-815.
[8]	Lianlian Zhang, Pinjing Hui, Yafang Ding. Clinical value of carotid Doppler ultrasonography in assessing vulnerability of atherosclerotic plaques [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 816-821.
[9]	Yaping Jia, Shu'e Zeng. Ultrasound and pathological characteristics of breast metaplastic carcinoma containing squamous cell carcinoma components [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 844-848.
[10]	Gang Luo, Silin Pan, Taotao Chen, Qian Xu, Zhixian Ji, Sibao Wang, Lingyu Sun. Application of echocardiography in fetal cardiac intervention of pulmonary atresia with intact ventricular septum [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 605-609.
[11]	Jia Huang, Hua Shi, Yuguo Zhang, Jiaqi Hu, Qian Chen. Ultrasonographic features of normal and abnormal fetal left brachiocephalic vein and their clinical significance [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 610-617.
[12]	Jun Zhang, Zai Luo, Mingyu Duan, Zhengjun Qiu, Chen Huang. Research progress of prognostic prediction models for gastric cancer [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 456-461.
[13]	Xu Tang, Bing Han, Wei Liu, Ruxing Chen. Analysis of risk factors for metachronous liver metastases after radical colorectal cancer surgery and construction of a predictive model [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 16-20.
[14]	Mei Liao, Hongjun Zhang, Jieyang Jin, Yan Lyu, Jie Ren. Diagnostic value of bedside contrast-enhanced ultrasound for early hepatic artery thrombosis after liver transplantation [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 630-634.
[15]	Tianchi Yang, Wei Han, Feng Qiu, Jiahui Qi. Evaluation of pancreatic texture by intraoperative ultrasonic elastography [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 646-650.

Please choose a citation manager

Content to export