| Objective:To investigate the predictive value of left ventricular diastolic function on mechanical ventilation weaning in patients with left ventricular ejection fraction(LVEF)> 0.50.Method:This study analyzed the clinical data of patients with respiratory failure who were admitted to the intensive care unit(ICU)of the Fourth Hospital of Hebei Medical University from August 2017 to February 2018 and whose mechanical ventilation was over 72 hours.The clinical data and parameters of echocardiography before spontaneous breathing trial(SBT)were collected.and the results of cardiac ultrasound,diastolic function-related index analysis of patients with left ventricular diastolic function and weaning outcome.According to the success and failure of patient weaning were divided into weaning success group and weaning failure group,comparing the clinical data and diastolic function related indexes of the two groups.The receiver operating characteristic curve(ROC)was used to assess the predictive value of left ventricular diastolic function in patients with mechanical ventilation ventilator.Results: A total of 35 patients were included in this study,all of the patient were the first weaning,including 23 males and 12 females.There were32 patients with hypertension,5 patients with COPD,14 with diabetes,and 11 patients with smoking history.11 patients failed SBT,24 patients were weaning success.Compared with patients in weaning success and weaning failure,patients with weaning success had lower heart rate,slower breathing rate and higher oxygenation index,but these data were no significant difference.The patients with weaning success who had a lower rate of fast breathing index than those with weaning failure,mechanical ventilation time and length of ICU stay were significantly lower than those with weaning failure(P <0.05).Compared with the weaning success group:At pre-SBT,Patients who failed weaning presented increased lateral E/Em、septal E/Em、averaged E/Em,and E/Vp:(11.890±3.429 vs 6.674±1.205,t=-4.6509,P=0.000;12.506±4.337 vs 7.595±1.436,t=-3.666,P=0.004: 11.443±3.798vs7.133±1.258,t=-3.673,P=0.004;2.295±0.816 vs 1.377±0.192,t=-3.681,P=0.004),they also had lower septal Em 、 lateral Em and Vp:(7.46±1.79 vs 10.35±1.57,t=4.843,P=0.000:7.50±1.10 vs 11.73±1.36,t=9.045,P=0.000;39.23±4.85 vs 56.18±8.26,t=7.593,P=0.000),and the rapid shallow breathing index(RSBI)was also increased significantly(71.82±19.286 vs 48.58±5.356,t=-3.927,P=0.002).ROC curve results show that the basic left ventricular diastolic function at pre-SBT had the diagnostic performance in predicting the outcome of weaning from mechanical ventilation,especially E/Vp and lateral E/Em.PreSBT values of E/Vp greater than 1.72 and lateral E/Em greater than 7.7predicted weaning failure with an area under the ROC curve(AUC),sensitivity,and specificity of 0.873±0.027 and 0.877±0.020,83.3% and91.7%,81.8% and 81.8%,respectively.The AUC of combination of E/Vp >1.72 and lateral E/Em>7.7 predicting weaning failure was 0.881±0.020 with a sensitivity of 91.7% and a specificity of 95.7%.Conclusions: The study found that In patients with normal systolic function,diastolic dysfunction has a significant effect on the weaning outcome of patients with mechanical ventilation and it can predict the weaning outcome.Assessment of left ventricular diastolic function using echocardiographic parameters: lateral E/Em,E/Vp,The combination of E/Vp and lateral E/Em may identify patients at high risk of weaning failure. |
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