Diastolic dysfunction as a predictor of weaning failure: a systematic review and meta-analysis

Abstract Purpose Weaning failure and prolonged mechanical ventilation are associated with increased morbidity, cost of care and high mortality rates. In the last few years, cardiac performance has been recognized as a common etiology of weaning failure, and growing evidence suggests that left ventricular diastolic dysfunction (DD) is a key factor that determines weaning outcomes. Therefore, we performed a systematic review and a meta-analysis to evaluate whether diastolic dysfunction in the critically ill patient subjected to mechanical ventilation is an independent predictor of weaning failure. Materials and methods We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, Google Scholar and ClinicalTrials.gov from inception to September 2014, along with conferences proceeding from January 2005 through September 2014 and included Observational Studies and Randomized Clinical Trials evaluating predictors of weaning failure. Results Ten studies were included in the systematic review and 7 in the meta-analysis (six observational studies and one randomized controlled trial). Patients who developed weaning failure had a higher E/e’ ratio when compared with those who did not (mean difference 2.65, 95% CI 0,52 to 4,79; p = 0.01); however, there was no difference in the E/A ratio (mean difference 0.07, 95% CI − 0.04 to 0.18; p = 0.22). Both the E/e’ and E/A ratios were associated with weaning-induced pulmonary edema at the end of a spontaneous breathing trial. Conclusion A higher E/e’ ratio is significantly associated with weaning failure, though a high heterogeneity of DD criteria and different clinical scenarios limit additional conclusions linking diastolic dysfunction with weaning failure.