Diaphragm and Lung Ultrasonography During Weaning From Mechanical Ventilation in Critically Ill Patients.

Funda Gok,Alper Yosunkaya,Gamze Sarkilar,Alper Kilicaslan,Aysel Mercan

doi:10.7759/cureus.15057

Abstract

Aim: Optimum timing is crucial to avoid negative outcomes of weaning. We aimed to investigate predictive values of diaphragmatic thickening fraction (DTF), diaphragmatic excursion (DE), and anterolateral lung ultrasound (LUS) scores in extubation success and compare with rapid shallow breathing index (RSBI) in patients extubated under traditional parameters.Methods: Patients undergoing mechanical ventilation for >48 hours were included in the study. In patients planned for extubation, sonographic evaluations of the diaphragm and lung were performed at the T-tube stage. RSBI was achieved in the pressure support (PS) ventilation stage. Predictive values of DTF, DE, and anterolateral LUS scores were compared with RSBI in extubation success.Results: Sixty-two patients were enrolled in the study. The study population consisted mostly of trauma patients (77%). A cut-off value of 64 was obtained for RSBI. The positive predictive value (PPV) was found at 97% in extubation success. Cut-off values of 27.5 for DTF, 1.3 cm for the DE, and 6.5 for LUS scores were obtained at the T-tube stage, respectively. PPVs of all sonographic parameters were found over 90%. At the first stage, weaning and extubation failures were determined as 35 and 9.6%, respectively. RSBI was found as a powerful parameter in determining extubation success (r=0.774, p≤0.001) and moderately correlated with sonographic parameters.Conclusion: Investigating the lung and diaphragm via ultrasound provides real-time information to increase extubation success. Cut-off values of 64 for RSBI, 27.5 for DTF, 1.3 cm for the DE, and 6.5 for LUS scores were obtained, respectively, and PPVs of all sonographic parameters were found over 90%. We consider that sonographic evaluations accompanied by an RSBI will increase extubation success in the weaning process.

Highlights

A great majority of the patients followed up in the intensive care units (ICU) are composed of those receiving mechanical ventilation (MV) therapy due to respiratory failure
A total of 22 (35%) patients were defined as weaning failure
The sonographic values obtained at T-tube stages had a positive predictive value (PPV) over 90% in determining the success of extubation

Summary

Introduction

A great majority of the patients followed up in the intensive care units (ICU) are composed of those receiving mechanical ventilation (MV) therapy due to respiratory failure. Termination or unnecessary delays in weaning leads to various negative consequences [1,2,3]. Among these results, the existence of serious consequences such as ventilator-associated pneumonia, ventilator-induced diaphragm atrophy, resumption of mechanical ventilator therapy indicates the importance of correct timing of weaning decisions. Since the breathing process is carried out by the diaphragm and auxiliary respiratory muscles, RSBI can be at desired values due to the auxiliary respiratory muscles, even if the diaphragm function is insufficient, meaning that RSBI values will be misleading in making the weaning decision [5,6]

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