Weaning failure of cardiovascular origin: how to suspect, detect and treat—a review of the literature

摘要: Among the multiple causes of weaning failure from mechanical ventilation, cardiovascular dysfunction is increasingly recognized as a quite frequent cause that can be treated successfully. In this review, we summarize contemporary evidence most important clinical and diagnostic aspects origin with special focus on treatment. Pathophysiological mechanisms are complex mainly include increase in right left ventricular preload afterload potentially induce myocardial ischemia. Patients at risk those preexisting cardiopulmonary disease either known or suspected. Clinically, etiology predominant contributor to failure, though critical for early diagnosis intervention, may difficult distinguished noncardiac suggesting need high suspicion. A workup including bedside echocardiography, lung ultrasound, electrocardiogram biomarkers other adjunct techniques and, selected cases, heart catheterization and/or coronary angiography, should obtained confirm diagnosis. Official practice guidelines address treatment confirmed weaning-induced do not exist. As etiologies diverse, principles management depend individual pathophysiological mechanisms, optimization by fluid removal, guided B-type natriuretic peptide measurement, nitrates administration excessive ischemia, contractility improvement severe systolic well rational specific indications order lead successful ventilation.