The application value of diaphragm ultrasound in the weaning of ventilator for patients undergoing heart valve replacement

Abstract

Objective: To explore the role of diaphragm ultrasound in guiding the successful weaning of ventilators in patients undergoing heart valve replacement. Methods: Prospectively selected 103 patients who received heart valve replacement in the Department of Cardiac Surgery, Fuwai Hospital of the Chinese Academy of Medical Sciences from December 2019 to February 2021 were selected, who have received mechanical ventilation for ≥48 h and have entered the pre-weaning spontaneous breathing test. The patients were divided into a successful weaning group (n=83) and failed weaning group (n=20) according to the patient's weaning result. Receiver operating characteristic (ROC) curve was used to evaluate the value of diaphragm thickening rate and diaphragmatic excursion to predict the result of ventilator weaning. Results: Among 83 patients in the successful weaning group, 52 were male patients and 31 were female patients, with an average age of (56.5±5.5) years; 20 patients in the failed weaning group included 12 male patients and 8 female patients, with an average The age is (57.3±6.2) years old.The left DTF, right DTF, left DE, and right DE of the patients in the successfully weaned group were (39.0±17.8)%, (57.7±1.2)%, (11.9±4.3) mm, (18.5±1.4) mm, respectively, which were higher than those in the weaning failure group (18.1±4.5)%, (19.9±2.3)%, (6.2±2.8) mm, (11.9±1.5) mm, respectively. And the differences were statistically significant (all P<0.05). ROC curve analysis showed that the best cut-off values, the sensitivity and the specificity for the thickening rate of the left diaphragms of patients with successful weaning were 61%, 90.46% and 87.83%, respectively; while the best cut-off values, the sensitivity and the specificity for the thickening rate of the right diaphragms of patients with successful weaning were 88%, 96.07% and 89.67%, respectively. The optimal cut-off values, the sensitivity and the specificity of mobility of the left right diaphragms of patients are 11.3 mm, 81.38% and 80.24%, respectively; while the optimal cut-off values, the sensitivity and the specificity of right diaphragms of patients were 12.7 mm, 87.23% and 85.56%, respectively. Conclusion: Diaphragm ultrasound can more accurately predict the outcome of ventilator weaning in patients undergoing heart valve replacement surgery, and it has good clinical application value.