Left ventricular systolic function and mechanical ventilation weaning failure: An updated systematic review and meta-analysis with trial sequential analysis.

Cristina Santonocito, Simone Messina, Mateusz Zawadka, Pruszczyk Andrzej, Elena Bignami, Andrea Morelli, Sabino Scolletta, Alberto Noto, Filippo Sanfilippo
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Abstract

Objective: The impact of left ventricular (LV) systolic dysfunction on weaning failure is unclear.

Design: Updated meta-analysis assessing the association between LV ejection fraction (LVEF) and weaning failure.

Setting: A systematic search of MEDLINE and EMBASE for prospective studies reporting weaning according to echocardiographic data measured before starting a spontaneous breathing trial (SBT).

Patients or participants: Studies included in the meta-analysis that reported on weaning and echocardiographic data.

Main variables of interest: LVEF, E/e' ratio, E velocity, deceleration time of the E wave, and e' velocity.

Results: Three studies were added in this update (n = 14, sample 20-30% larger). Lower LVEF (n = 12) was associated with weaning failure: MD: -4.71 95%CI [-9.18, -0.23]; p = 0.04, I2 = 90%, low certainty of evidence), without subgroups difference according to SBT type or LVEF mean values. Trial sequential analysis showed that results were not robust (information size n = 745/1378). E/e' ratio (MD: 1.90, 95%CI [0.48,3.32]; p = 0.009, I2 = 84%), E velocity (MD: 8.32, 95%CI [2.59,14.05]; p = 0.004, I2 = 54%) and shorter deceleration time of the E wave (MD: -12.01, 95%CI [-21.13, -2.89]; p = 0.01, I2 = 0%) were associated with weaning failure, whilst e' velocity was not (MD: -0.59, 95%CI [-1.51,0.32]; p = 0.20, I2 = 64%).

Conclusions: An association of weaning failure with poorer LV systolic function (LVEF), not detected by the previous meta-analysis, was found. However, such association is highly fragile and with a mean difference below 5%, which seems not clinically relevant. Higher E/e' ratio and other diastolic parameters confirmed their association with weaning failure, whilst e' did not.

左心室收缩功能与机械通气脱机失败:一项最新的系统综述和荟萃分析,采用试验序列分析。
目的:左室收缩功能障碍对断奶失败的影响尚不清楚。设计:更新meta分析,评估左室射血分数(LVEF)与脱机失败之间的关系。背景:对MEDLINE和EMBASE进行系统搜索,以获得根据开始自主呼吸试验(SBT)前测量的超声心动图数据报告脱机的前瞻性研究。患者或参与者:meta分析中包括的关于脱机和超声心动图数据的研究。主要感兴趣的变量:LVEF, E/ E′比,E′速度,E波减速时间,E′速度。结果:本次更新中增加了3项研究(n = 14,样本量增加20-30%)。较低的LVEF (n = 12)与断奶失败相关:MD: -4.71 95%CI [-9.18, -0.23];p = 0.04, I2 = 90%,证据确定性低),根据SBT类型或LVEF平均值,无亚组差异。试验序贯分析显示结果不稳健(信息大小n = 745/1378)。E/ E比值(MD: 1.90, 95%CI [0.48,3.32];p = 0.009, I2 = 84%), E速度(MD: 8.32, 95% ci (2.59, 14.05);p = 0.004, I2 = 54%), E波减速时间更短(MD: -12.01, 95%CI [-21.13, -2.89];p = 0.01, I2 = 0%)与断奶失败相关,而e' velocity与断奶失败无关(MD: -0.59, 95%CI [-1.51,0.32];p = 0.20, I2 = 64%)。结论:我们发现脱机失败与较差的左室收缩功能(LVEF)存在关联,这在之前的荟萃分析中未被发现。然而,这种关联是非常脆弱的,平均差异低于5%,似乎没有临床相关性。较高的E/ E′比和其他舒张参数证实了它们与断奶失败的关联,而E′没有。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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