3.8 Article

Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index

Journal

ACUTE AND CRITICAL CARE
Volume 37, Issue 1, Pages 94-100

Publisher

KOREAN SOC CRITICAL CARE MEDICINE
DOI: 10.4266/acc.2021.01354

Keywords

airway extubation; diaphragm excursion; diaphragm thickening fraction; rapid shallow breathing index; ventilator weaning

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Diaphragm excursion and thickening fraction are better indicators for predicting successful extubation from mechanical ventilation.
Background: In 3%-19% of patients, reintubation is needed 48-72 hours following extubation, which increases intensive care unit (ICU) morbidity, mortality, and expenses. Extubation failure is frequently caused by diaphragm dysfunction. Ultrasonography can be used to determine the mobility and thickness of the diaphragm. This study looked at the role of diaphragm excursion (DE) and thickening fraction in predicting successful extubation from mechanical ventilation. Methods: Thirty-one patients were extubated with the advice of an ICU consultant using the ICU weaning regimen and diaphragm ultrasonography was performed. Ultrasound DE and thickening fraction were measured three times: at the commencement of the T-piece experiment, at 10 minutes, and immediately before extubation. All patients' parameters were monitored for 48 hours after extubation. Rapid shallow breathing index (RSBI) was also measured at the same time. Results: Successful extubation was significantly correlated with DE (P<0.001). Receiver curve analysis for DE to predict successful extubation revealed good properties (area under the curve [AUC), 0.83; P<0.001); sensitivity, 77.8%; specificity, 84.6%; positive predictive value (PPV), 84.6 %; negative predictive value (NPV), 73.3 % while cut-off value, 11.43 mm. Diaphragm thickening fraction (DTF) also revealed moderate curve properties (AUC, 0.69; P=0.06); sensitivity, 61.1%; specificity, 84.6 %; PPV, 87.5%; NPV, 61.1% with cut-off value 22.33 % although former one was slightly better. RSBI could not reach good receiver operating characteristic value at cut-off points 100 breaths/mink (AUC, 0.58; P=0.47); sensitivity, 66.7 %; specificity, 53.8%; PPV, 66.7 %; NPV, 53.8%). Conclusions: To decrease the rate of reintubation, DE and DTF are better indicators of successful extubation. DE outperforms DTF.

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