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1 From the Pulmonary and Critical Care Division, Bridgeport (Conn) Hospital and Yale University School of Medicine, New Haven, Conn.
In this prospective study, we measured the ST segments, heart rate-systolic BP product (RPP), respiratory rate to tidal volume ratio (RVR), and pulse oximetry saturations of patients in our medical/cardiac ICUs before and during weaning from mechanical ventilation. Ninety-three patients were enrolled with a mean age of 66.5±15.0 years (mean±SD), mean acute physiology and chronic health evaluation (APACHE) II score of 16.0±6.9, and mean duration of mechanical ventilation of 5.2±8.6 days. Forty-nine patients had coronary artery disease (CAD). Six of 93 patients (6.4%) experienced ECG evidence of ischemia during weaning. Five of these six had a precedent history of CAD and four failed initial weaning attempts (22% of patients with CAD who failed weaning). The RPP, for the group as a whole, increased significantly during weaning from 12.0±3.1 to 13.4±4.0 mm Hg·bpm·103 (p<0.01). The rate to volume ratio did not change significantly during weaning, except in the subgroup of patients who failed to wean, in whom it increased from 98.4±45.2 to 124.9±54.9 bpm/L (p<0.05). Oxygenation also decreased significantly from 0.98±0.02 to 0.96±0.03 and was significantly associated with weaning failure (risk ratio [RR]=3.9; 95% confidence interval [CI]= 1.7 to 9.0). Thirty-seven patients failed the initial weaning attempt. Cardiac ischemia (RR=1.8; 95% CI=1.0 to 3.4) and an increased RVR (RR=1.7; 95% CI=0.9 to 3.4) tended to increase the risk of weaning failure. Cardiac ischemia, although infrequent (6%) in the general population of weaning medical/cardiac ICU patients, should be considered in patients with CAD who fail to wean.
Key Words: electrocardiogram • ischemia • mechanical ventilation • oxygen consumption • ST segment • weaning • work of breathing
Submitted on September 13, 1995
Accepted on November 17, 2007
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