The Use of Transoesophageal Doppler and Central Venous Oxygen Saturation as Predictors of Weaning Success

Published:January 13, 2022DOI:https://doi.org/10.1053/j.jvca.2022.01.010

      Abstract

      Objectives

      : Weaning individuals from mechanical ventilation (MV) is a challenge to physicians. Respiratory failure is the main reason for weaning failure (WF), but heart failure plays a pivotal role as well. Transoesophageal Doppler (TED) is a minimally invasive method of haemodynamic tracking with fewer problems. We evaluated the role of TED in predicting WF.

      Design

      : Observational study.

      Setting

      : University Teaching Hospital.

      Participants

      : Weaning individuals.

      Interventions

      : TED was applied before initiating the spontaneous breathing trial (SBT). Haemodynamic parameters, arterial blood gases, and TED [peak velocity (PV), cardiac output (COP)] were reported while cases were on MV before initiating the SBT and at the successful completion of SBT. Succeeded (group S) and failed individuals (group F who needed reintubation within 48 hours) were compared. Sensitivity, specificity, and area under receiver operating curve (AUROC) were calculated. A subgroup of patients with cardiac comorbidities and impaired cardiac contractility were further analyzed.

      Measurements & Main Results

      : We included 39 critically ill cases for weaning from MV. The re-intubation rate was 54.8%. In patients with cardiac morbidity; delta change in PV and COP as predictors of WF showed 100% sensitivity and specificity with 18 and 14% cutoffs after initiating the SBT (dC between the beginning and end of the succesfful SBT), respectively. Besides, ScVO2 revealed a significant difference between patients with cardiac morbidity and non-cardiac cases with lower sensitivity and specificity in the prediction of WF.

      Conclusions

      : TED could be a helpful method for the weaning of patients with cardiac morbidity from MV. Delta change in PV and COP >18% and >14% are significant predictors of WF in these subjects, respectively.

      Keywords

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