Evaluation of Left Ventricular Function to Predict Weaning Success in the Intensive Care Unit

Kanuni Sultan Suleyman Training and Research Hospital50 enrolled

Overview

The goal of this prospective observational study is to evaluate whether left ventricular function parameters assessed via transthoracic echocardiography (TTE) can predict weaning success from mechanical ventilation in adult intensive care unit (ICU) patients. The main questions it aims to answer are: Can the Left Ventricular Outflow Tract Velocity Time Integral (LVOT VTI) predict successful extubation? What is the prognostic value of other echocardiographic measures such as Mitral Annular Plane Systolic Excursion (MAPSE), E/e' ratio, E/A ratio, Mitral Deceleration Time (MDT), and Myocardial Performance Index (Tei index) in forecasting weaning outcomes? Participants will: Be adults receiving mechanical ventilation and scheduled for weaning Undergo transthoracic echocardiography (TTE) within 2 hours after meeting weaning criteria Have the following parameters measured: LVOT VTI, MAPSE, E/e', E/A, MDT, and Tei index Be monitored for 24 hours post-extubation to determine if they remain off ventilatory support, including reintubation, non-invasive ventilation, or high-flow oxygen therapy This study aims to provide a comprehensive understanding of how systolic, diastolic, and global cardiac functions influence extubation success, potentially improving ICU decision-making and reducing complications, length of stay, and healthcare costs.

This prospective, single-center observational study aims to assess the predictive value of left ventricular function parameters obtained via transthoracic echocardiography (TTE) in determining weaning success in mechanically ventilated adult ICU patients. Following fulfillment of weaning criteria, patients will undergo TTE evaluation within 2 hours. The echocardiographic assessment will include the measurement of: Left Ventricular Outflow Tract Velocity Time Integral (LVOT VTI) Mitral Annular Plane Systolic Excursion (MAPSE) E/e' ratio E/A ratio Mitral Deceleration Time (MDT) Myocardial Performance Index (Tei index) These measurements aim to reflect systolic, diastolic, and global left ventricular functions. After the echocardiographic assessment, patients will be followed for 24 hours to determine weaning success, defined as the ability to maintain spontaneous breathing without reintubation, non-invasive ventilation, or high-flow oxygen support. By integrating non-invasive, bedside cardiac function assessments into the extubation decision-making process, the study seeks to contribute to more physiologically guided weaning strategies. The results may help reduce weaning-related complications and optimize resource use in critical care settings

Study Type

Interventions

Echocardiographic AssessmentDIAGNOSTIC_TEST

All participants will receive a standardized transthoracic echocardiographic (TTE) examination within 2 hours after meeting weaning criteria. The following cardiac function parameters will be recorded: LVOT Velocity Time Integral (VTI) Mitral Annular Plane Systolic Excursion (MAPSE) E/e' ratio E/A ratio Mitral Deceleration Time (MDT) Myocardial Performance Index (Tei index) The echocardiographic data will be used to investigate the association between left ventricular function and weaning success.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Currently receiving mechanical ventilation in the ICU * Planned extubation after meeting standard weaning criteria * Hemodynamically stable at the time of echocardiographic evaluation * Written informed consent obtained from the patient or legally authorized representative Exclusion Criteria: * Surgery within the previous 24 hours * Presence of significant valvular heart disease or known cardiomyopathy * Inadequate acoustic window for transthoracic echocardiography * Ongoing use of extracorporeal support (e.g., ECMO) * Patients with Do-Not-Resuscitate (DNR) orders or expected to die within 24 hours * Re-intubation planned prophylactically regardless of clinical status * Pregnant patients

Outcomes

Primary Outcomes

Predictive Value of LVOT VTI in Determining Weaning Success

To evaluate whether the Left Ventricular Outflow Tract Velocity Time Integral (LVOT VTI) measured by transthoracic echocardiography (TTE) within 2 hours after fulfilling weaning criteria can predict successful weaning from mechanical ventilation. Successful weaning is defined as maintaining spontaneous breathing for at least 24 hours without requiring reintubation, non-invasive ventilation, or high-flow nasal oxygen therapy.

Time frame: Within 24 hours after extubation

Secondary Outcomes

Predictive Value of Additional Left Ventricular Function Parameters in Weaning Success

To assess whether echocardiographic parameters other than LVOT VTI - including Mitral Annular Plane Systolic Excursion (MAPSE), E/e' ratio, E/A ratio, Mitral Deceleration Time (MDT), and Myocardial Performance Index (Tei index) - are associated with successful weaning from mechanical ventilation. These parameters reflect systolic, diastolic, and global left ventricular function and will be measured using transthoracic echocardiography prior to extubation.