Department of Anesthesia and Critical Care, Cairo University Hospital, Cairo, Egypt.
Respir Care. 2019 May;64(5):564-569. doi: 10.4187/respcare.06391. Epub 2019 Jan 22.
Sepsis-induced diaphragmatic dysfunction is one of the main risk factors of failure to liberate patients from mechanical ventilation. Several studies addressed diaphragmatic ultrasound as a valuable tool in the assessment of diaphragmatic function during liberation from mechanical ventilation in different populations. However, none of these studies examined the use of diaphragmatic ultrasound to predict failure of liberation from mechanical ventilation in subjects with sepsis METHODS: A prospective observational study was done with subjects on mechanical ventilation and with abdominal sepsis. The diaphragmatic thickening fraction, diaphragmatic excursion, and rapid shallow breathing index were assessed 30 min after a spontaneous breathing trial RESULTS: Thirty subjects were enrolled in the study. Seventeen subjects were successfully extubated (56.6%), whereas extubation failed in 13 subjects (43.4%). The time to the first liberation attempt was significantly shorter in the liberation-success group 2.3 (0.7) d compared with the liberation-failure group 5.8 (4.7) d; = .02. The optimum cutoff value of diaphragmatic thickening fraction for predicting liberation success was ≥30.7%, with a sensitivity of 94.1% and a specificity of 100%. The area under the curve was 0.977. Although diaphragmatic excursion of ≥10.4 mm had a sensitivity of 94% and a specificity of 85% for predicting liberation success, with an area under the curve of 0.85. A rapid shallow breathing index of ≤44 had a specificity of 100% and a sensitivity of 76%; the area under the curve was 0.9.
Diaphragmatic ultrasound indices, namely diaphragmatic thickening fraction and diaphragmatic excursion, could be useful parameters for assessment of success of liberation in patients on mechanical ventilation with abdominal sepsis. (ClinicalTrials.gov registration NCT03094299.).
脓毒症引起的膈肌功能障碍是导致患者无法脱离机械通气的主要危险因素之一。多项研究表明，在不同人群中，膈肌超声检查是评估机械通气脱机时膈肌功能的一种有价值的工具。然而，这些研究均未探讨使用膈肌超声检查来预测患有脓毒症的患者机械通气脱机失败的情况。
这是一项针对接受机械通气和腹部感染的患者的前瞻性观察性研究。在自主呼吸试验后 30 分钟，评估膈肌增厚分数、膈肌移动度和浅快呼吸指数。
该研究共纳入 30 名患者。17 名患者（56.6%）成功拔管，而 13 名患者（43.4%）拔管失败。在成功拔管组中，首次尝试脱机的时间明显短于脱机失败组（2.3[0.7]d 比 5.8[4.7]d；P=.02）。预测脱机成功的膈肌增厚分数最佳截断值≥30.7%，其敏感性为 94.1%，特异性为 100%。曲线下面积为 0.977。虽然膈肌移动度≥10.4mm 预测脱机成功的敏感性为 94%，特异性为 85%，曲线下面积为 0.85，但也有局限性。浅快呼吸指数≤44 时特异性为 100%，敏感性为 76%，曲线下面积为 0.9。
膈肌超声指标，即膈肌增厚分数和膈肌移动度，可作为评估腹部感染患者机械通气脱机成功的有用参数。（临床试验注册号：NCT03094299。）
