Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation

被引：243
作者：
Ferrari G. [1 ]
De Filippi G. [1 ]
Elia F. [1 ]
Panero F. [1 ]
Volpicelli G. [2 ]
Aprà F. [1 ]
机构：
[1] High Dependency Unit, San Giovanni Bosco Hospital, Turin, 10154
[2] Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Turin
来源：
Critical Ultrasound Journal | 2014年 / 6卷 / 1期
关键词：
Diaphragm; Ultrasonography; Weaning;
D O I：
10.1186/2036-7902-6-8
中图分类号：
学科分类号：
摘要：
Background: Predictive indexes of weaning from mechanical ventilation are often inaccurate. Among the many indexes used in clinical practice, the rapid shallow breathing index is one of the most accurate. We evaluated a new weaning index consisting in the diaphragm thickening fraction (DTF) assessed by ultrasound. Methods: Forty-six patients were prospectively enrolled. All patients were ventilated in pressure support through a tracheostomy tube. Patients underwent a spontaneous breathing trial (SBT) when they met all the following criteria: FiO2 < 0.5, PEEP ≤5 cmH2O, PaO2/FiO2 > 200, respiratory rate <30 breaths per minute, absence of fever, alert and cooperative, and hemodynamic stability without vaso-active therapy support. During the trial, the right hemi-diaphragm was visualized in the zone of apposition using a 10-MHz linear ultrasound probe. The patient was then instructed to perform breathing to total lung capacity (TLC) and then exhaling to residual volume (RV). Diaphragm thickness was recorded at TLC and RV, and the DTF was calculated as percentage from the following formula: Thickness at end inspiration - Thickness at end expiration / Thickness at end expiration. Also, the rapid shallow breathing index (RSBI) was calculated. Weaning failure was defined as the inability to maintain spontaneous breathing for at least 48 h, without any form of ventilatory support. Results: A significant difference between diaphragm thickness at TLC and RV was observed both in patients who succeeded SBT and patients who failed. DTF was significantly different between patients who failed and patients who succeeded SBT. A cutoff value of a DTF >36% was associated with a successful SBT with a sensitivity of 0.82, a specificity of 0.88, a positive predictive value (PPV) of 0.92, and a negative predictive value (NPV) of 0.75. By comparison, RSBI <105 had a sensitivity of 0.93, a specificity of 0.88, a PPV of 0.93, and a NPV of 0.88 for determining SBT success. Conclusions: This study shows that in our cohort of patients, the assessment of DTF by diaphragm ultrasound may perform similarly to other weaning indexes. If validated by other studies, this method may be used in clinical practice. © 2014 Ferrari et al.; licensee Springer.
引用
收藏
页码：1 / 6
页数：5
相关论文
共 21 条
  • [1] Esteban A., Frutos F., Tobin M.J., Alia I., Solsona J.F., Valverdu I., Fernandez R., de La Cal M.A., Benito S., Tomas R., Carriedo D., Macias S., Blanco J., A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group, N Engl J Med, 332, pp. 345-350, (1995)
  • [2] El-Khatib M.F., Bou-Khalil P., Clinical review: liberation from mechanical ventilation, Crit Care, 12, (2008)
  • [3] Yang K.L., Tobin M.J., A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation, N Engl J Med, 324, pp. 1445-1450, (1991)
  • [4] Epstein S.K., Etiology of extubation failure and the predictive value of the rapid shallow breathing index, Am J Respir Crit Care Med, 152, pp. 545-549, (1995)
  • [5] Lee K.H., Hui K.P., Chan T.B., Tan W.C., Lim T.K., Rapid shallow breathing (frequency-tidal volume ratio) did not predict extubation outcome, Chest, 105, pp. 540-543, (1994)
  • [6] Krieger B.P., Isber J., Breitenbucher A., Throop G., Ershowsky P., Serial measurements of the rapid-shallow-breathing index as a predictor of weaning outcome in elderly medical patients, Chest, 112, pp. 1029-1034, (1997)
  • [7] Vassilakopoulos T., Zakynthinos S., Roussos C., The tension-time index and the frequency/tidal volume ratio are the major pathophysiologic determinants of weaning failure and success, Am J Respir Crit Care Med, 158, pp. 378-385, (1998)
  • [8] Petrof B.J., Jaber S., Matecki S., Ventilator-induced diaphragmatic dysfunction, Curr Opin Crit Care, 16, pp. 19-25, (2010)
  • [9] Lerolle N., Guerot E., Dimassi S., Zegdi R., Faisy C., Fagon J.Y., Diehl J.L., Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery, Chest, 135, pp. 401-407, (2009)
  • [10] Matamis D., Soilemezi E., Tsagourias M., Akoumianaki E., Dimassi S., Boroli F., Richard J.C., Brochard L., Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications, Intensive Care Med, 39, pp. 801-810, (2013)
123