[Usefulness of diaphragmatic ultrasound in predicting extubation success]

OBJECTIVE

To evaluate the diagnostic accuracy of diaphragmatic ultrasound in predicting extubation success.

DESIGN

A diagnostic accuracy study was carried out.

SCOPE

Intensive Care Unit of an Academic hospital in the city of Bogotá (Colombia).

PATIENTS OR PARTICIPANTS

A consecutive sample of patients >18 years of age subjected to invasive mechanical ventilation for >48h.

INTERVENTIONS

Diaphragmatic ultrasound evaluation at the end of spontaneous ventilation testing.

MAIN VARIABLES OF INTEREST

Diaphragmatic excursion (DE, cm), inspiration time (TPIA_dia, s), diaphragm contraction speed (DE/TPIA_dia, cm/s) and total time (Ttot, s) were evaluated, together with thickening fraction (TF_di, %).

RESULTS

A total of 84 patients were included, 79.8% (n=67) with successful extubation and 20.2% (n=17) with failed extubation. The variable with the best discriminatory capacity in predicting extubation success was diaphragm contraction speed, with AUC-ROC 0.70 (p=0.008).

CONCLUSIONS

Diaphragm contraction speed exhibited acceptable discriminatory capacity. Ultrasound could be part of a multifactorial approach in the extubation process.

Patients' experience during weaning of invasive mechanical ventilation: A review of the literature

OBJECTIVE

Weaning from invasive mechanical ventilation (IMV) is influenced by physiological and psychological factors, the latter being the least studied. The aim was to identify, through the literature, patients' experiences during weaning from IMV and report its influencing factors.

METHOD

The literature search was conducted using the Pubmed, CINAHL and PsycINFO databases. The search terms were: "patient", "experience" and "ventilator weaning". The research limits were: age (>19years) and language (English, Spanish and Finnish).

RESULTS

Fifteen publications were analysed. The main results were grouped into three main categories according to patient's perceptions, feelings and experiences, influence of professionals' attention and determinants for successful weaning. Patients remember IMV weaning as a stressful process where they experience anxiety, frustration, despair or uncertainty. Nurses have a key role in improving communication with patients and foreseeing their needs. Family support and the care provided by the caregivers were shown as essential during the process. The patient's self-determination, self-motivation and confidence are identified as important factors to achieve successful IMV weaning.

CONCLUSIONS

Psychological care, in addition to physical and technical care, is important at providing holistic care. Interventional studies are needed to improve the care during the weaning experience.