Yoo Jung-Wan, Lee Seung Jun, Lee Jong Deog, Kim Ho Cheol
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea.
Korean J Intern Med. 2018 Mar;33(2):331-339. doi: 10.3904/kjim.2016.152. Epub 2017 Oct 19.
BACKGROUND/AIMS: Both diaphragmatic excursion and change in muscle thickening are measured using ultrasonography (US) to assess diaphragm function and mechanical ventilation weaning outcomes. However, which parameter can better predict successful extubation remains to be determined. The aim of this study was to compare the clinical utility of these two diaphragmatic parameters to predict extubation success.
This study included patients subjected to extubation trial in the medical or surgical intensive care unit of a university-affiliated hospital from May 2015 through February 2016. Diaphragm excursion and percent of thickening change (Δtdi%) were measured using US within 24 hours before extubation.
Sixty patients were included, and 78.3% (47/60) of these patients were successfully extubated, whereas 21.7% (13/60) were not. The median degree of excursion was greater in patients with extubation success than in those with extubation failure (1.65 cm vs. 0.8 cm, < 0.001). Patients with extubation success had a greater Δtdi% than those with extubation failure (42.1% vs. 22.5%, = 0.03). The areas under the receiver operating curve for excursion and Δtdi% were 0.836 (95% confidence interval [CI], 0.717 to 0.919) and 0.698 (95% CI, 0.566 to 0.810), respectively ( = 0.017).
Diaphragm excursion seems more accurate than a change in the diaphragm thickness to predict extubation success.
背景/目的：使用超声（US）测量膈肌移动度和肌肉增厚变化，以评估膈肌功能和机械通气撤机结果。然而，哪个参数能更好地预测拔管成功仍有待确定。本研究的目的是比较这两个膈肌参数预测拔管成功的临床效用。
本研究纳入了2015年5月至2016年2月在一所大学附属医院的内科或外科重症监护病房接受拔管试验的患者。在拔管前24小时内使用超声测量膈肌移动度和增厚变化百分比（Δtdi%）。
纳入60例患者，其中78.3%（47/60）成功拔管，21.7%（13/60）未成功拔管。拔管成功患者的膈肌移动度中位数大于拔管失败患者（1.65 cm对0.8 cm，<0.001）。拔管成功患者的Δtdi%高于拔管失败患者（42.1%对22.5%，=0.03）。膈肌移动度和Δtdi%的受试者工作特征曲线下面积分别为0.836（95%置信区间[CI]，0.717至0.919）和0.698（95%CI，0.566至0.810）（=0.017）。
在预测拔管成功方面，膈肌移动度似乎比膈肌厚度变化更准确。
