Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients

Aim: To evaluate role of diaphragmatic thickening and excursion, assessed ultrasonographically, in pre-dicting extubation outcome. Methods: Fifty-four patients who successfully passed spontaneous breathing trial (SBT) were enrolled. They were assessed by ultrasound during SBT evaluating diaphragmatic excursion, diaphragmatic thickness (Tdi) at end inspiration, at end expiration and diaphragmatic thickness fraction (DTF%). Simul-taneously traditional weaning parameters were recorded. Patients were followed up for 48 h after extubation. Results: Out of 54 included patients, 14 (25.9%) failed extubation. Diaphragmatic excursion, Tdi at end inspiration, at end expiration and DTF% were significantly higher in the successful group compared to those who failed extubation (p < 0.05). Cutoff values of diaphragmatic measures associated with success-ful extubation were >= 10.5 mm for diaphragmatic excursion, >= 21 mm for Tdi at end inspiration, >= 10.5 mm for Tdi at end expiration, >= 34.2% for DTF% giving 87.5%, 77.5%, 80% and 90% sensitivity respectively and 71.5%, 86.6%, 50% and 64.3% specificity respectively. Combining diaphragmatic excursion >= 10.5 mm and Tdi at end inspiration >= 21 mm decreased sensitivity to 64.9% but increased specificity to 100%. Rapid shallow breathing index (RSBI) <105 had 90% sensitivity but 18.7% specificity. Conclusion: Ultrasound evaluation of diaphragmatic excursion and thickness at end inspiration could be a good predictor of extubation outcome in patients who passed SBT. It is recommended to consider the use of these parameters with RSBI consequently to improve extubation outcome. (C) 2016 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.