[The value of the excursion of diaphragm tested by ultrosonography to predict weaning from mechanical ventilation in ICU patients]

Sonographic evaluation of diaphragmatic thickness and excursion as a predictor for successful extubation in mechanically ventilated preterm infants

Sonographic assessment of diaphragmatic thickness and excursion has been found to be an accurate tool in predicting successful extubation of adult patients from invasive mechanical ventilation. We aimed to evaluate the accuracy of sonographic assessment of diaphragmatic thickness and excursion in predicting successful extubation of preterm infants from invasive conventional mechanical ventilation. Preterm infants less than 32 weeks gestation who required invasive conventional mechanical ventilation were evaluated by diaphragmatic sonography within 1 h of their planned extubation. Infants were classified into successful or failed extubation groups based on their ability to stay off invasive mechanical ventilation for 72 h after extubation. Inspiratory and expiratory thickness plus excursion of the right and left hemidiaphragm as well as diaphragmatic thickening fraction (DTF) measures were compared between groups. We included 43 eligible infants, of whom 34 infants succeeded and 9 infants failed extubation. Infants in the successful extubation group had a significantly higher expiratory thickness of the right and left hemidiaphragm, excursion of the right and left hemidiaphragm, inspiratory thickness of the left hemidiaphragm, and DTF of the left hemidiaphragm compared with infants who failed extubation. The receiver-operating characteristic curves showed that excursion of the right and left hemidiaphragm has the highest significant accuracy in predicting successful extubation of preterm infants among all diaphragmatic parameters (AUC is 0.98 and 0.96, respectively; p value < 0.001 for both).Conclusion: We conclude that diaphragmatic excursion is a useful indicator for successful extubation of preterm infants from mechanical ventilation. What is Known: • Invasive mechanical ventilation induces ventilator induced diaphragmatic dysfunction (VIDD) particularly when used for long time. • Assessment of diaphragmatic dimensions and functional activity has been a valuable tool in predicting successful extubation of adult patients from invasive mechanical ventilation. What is New: • Sonographic assessment of diaphragmatic dimensions can be used to predict successful extubation of preterm infants from mechanical ventilation. • Sonographic assessment of diaphragmatic excursion shows the highest sensitivity and specificity in predicting successful extubation of preterm infants.

Evaluation of diaphragm ultrasound in predicting extubation outcome in mechanically ventilated patients with COPD

Background

To explore the value of the right hemi-diaphragmatic excursion (DE) and its variation in predicting extubation outcome in mechanically ventilated patients with COPD.

Methods

All included patients with COPD received mechanical ventilation (MV) and were ready to wean from MV. After patients passed the 30 min spontaneous breathing trail (SBT), extubation was considered to be feasible, and the right DE measured by ultrasound at 0 min, 5 min, and 30 min of SBT were named as DE₀, DE₅, and DE₃₀, respectively.

Results

Twenty-five patients succeeded extubation; 12 patients failed. The area under receiver operator characteristic curve (AUC_ROC) of DE₃₀ and ΔDE₃₀₋₅ (the variation between 30 and 5 min) were 0.762 and 0.835; a cutoff value of DE₃₀ > 1.72 cm and ΔDE₃₀₋₅ > 0.16 cm were associated with a successful extubation with a sensitivity of 76% and 84%, a specificity of 75% and 83.3%, respectively. The predictive probability equation of the DE₃₀ plus ∆DE₃₀₋₅ was P = 1/[1 + e^{−(−5.625+17.689×∆DE}₃₀₋₅^+1.802×DE₃₀⁾], a cutoff value of P > 0.626 was associated with a successful extubation with the AUC_ROC of 0.867, a sensitivity of 92%, and a specificity of 83.3%.

Conclusion

The combination of DE₃₀ and ∆DE₃₀₋₅ could improve the predictive value and could be used as the predictor of extubation outcome in mechanically ventilated patients with COPD.

Diaphragmatic ultrasonography for predicting ventilator weaning: A meta-analysis

BACKGROUND

Weaning failure is common in mechanically ventilated patients. Whether ultrasound can predict weaning outcome remains controversial. This meta-analysis was performed to assess the accuracy of diaphragmatic ultrasonography for predicting reintubation within 48 hours of extubation.

METHODS

Literature search was performed in PubMed, Embase, and Cochrane Library to identify all the relevant papers, published in English up to July 16, 2017. Eligible studies were included if data were in adequate details to rebuild 2 × 2 contingency tables. Methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) in Review Manager 5.3. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve were pooled using the fixed or random effects model, meanwhile, the heterogeneity was evaluated using Cochran Q test and I statistics in Meta-DiSc 1.4. Publication bias was assessed using Deeks funnel plot in Stata 12.0.

RESULTS

Thirteen studies with 742 subjects were included in this meta-analysis. The pooled sensitivities for diaphragm excursion (DE) and diaphragm thickness fraction (DTF) were 0.786 and 0.893, and the pooled specificities were 0.711 and 0.796, respectively. The area under curve (AUC) for DE and DTF were 0.8590 and 0.8381. The DORs for DE and DTF were 10.623 and 32.521. No publication bias was observed among these studies.

CONCLUSIONS

Diaphragmatic ultrasonography is a promising tool for predicting reintubation within 48 hours of extubation. However, due to heterogeneities among the included studies, large-scale studies are warranted to confirm our findings.