Gu Caihong, Xie Yongpeng, Zheng Tao, Ren Huajian, Wang Gefei, Ren Jian'an
Research Institute of General Surgery, Jinling Hospital of Nanjing Medical University (East War Zone Hospital), Nanjing 210002, Jiangsu, China.
Department of Intensive Care Unit, the First People's Hospital of Lianyungang, Lianyungang 222000, Jiangsu, China. Gu Caihong is working on the Department of Intensive Care Unit, the First People's Hospital of Lianyungang, Lianyungang 222000, Jiangsu, China. Corresponding author: Ren Jian'an, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020 Jan;32(1):94-98. doi: 10.3760/cma.j.cn121430-20191127-00017.
To evaluate the value of lung ultrasound score (LUS) on predicting weaning outcome in patients with intro-abdominal infection (IAI) undergoing mechanical ventilation.
Patients with IAI undergoing mechanical ventilation admitted to Research Institute of General Surgery of East War Zone Hospital and intensive care unit (ICU) of the First People's Hospital of Lianyungang from January to December in 2018 were included. The patients who satisfied weaning criteria were enrolled in the weaning process, which included spontaneous breathing trial (SBT) and extubation. They were divided into SBT success group and SBT failure group according to whether passed 120-minute SBT or not. LUS scores before and after SBT were compared between the two groups. The patients in the SBT success group were extubated, and they were divided into successful extubation group and failed extubation group for sub-group analysis according to whether re-intubation was needed in 48 hours after extubation. LUS score before extubation (at the end of SBT) and 48 hours after extubation (48 hours after extubation in the successful extubation group or before re-intubation in the failed extubation group) were compared. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of LUS score before SBT for SBT failure and LUS score before extubation for the failure.
A total of 76 patients with IAI undergoing mechanical ventilation were included. Twenty-three patients had duration of mechanical ventilation less than 48 hours, severe chronic obstructive pulmonary disease (COPD), tracheotomy or automatic discharge were excluded, and 53 patients were enrolled. SBT was failed in 9 patients, and successfully performed in 44 patients, of whom 23 patients with successful extubation, and 21 with failed extubation. The LUS scores before and after SBT in the SBT failure group were significantly higher than those in the SBT success group (before SBT: 13.22±1.99 vs. 10.79±1.64, t = -3.911, P = 0.000; after SBT: 19.00±1.12 vs. 13.41±1.86, t = -8.665, P = 0.000). ROC curve analysis showed that the area under ROC curve (AUC) of LUS score before SBT for predicting SBT failure was 0.82 [95% confidence interval (95%CI) was 0.67-0.98, P = 0.002]. When the optimum cut-off value was 12.5, the sensitivity was 66.7%, and the specificity was 84.1%. Sub-group analysis showed that the LUS scores before and after extubation in the failed extubation group were significantly higher than those in the successful extubation group (before extubation: 14.19±1.60 vs. 12.69±1.81, t = -2.881, P = 0.006; after extubation: 16.42±1.59 vs. 12.78±1.54, t = -7.710, P = 0.000). ROC curve analysis showed that the AUC of LUS score before extubation for predicting the failure was 0.81 (95%CI was 0.69-0.92, P = 0.000). When the optimum cut-off value was 13.5, the sensitivity was 80.0%, and the specificity was 65.2%.
LUS score can effectively predict SBT outcome, risk of re-intubation after extubation in patients with IAI undergoing mechanical ventilation.
评估肺部超声评分（LUS）对腹部感染（IAI）接受机械通气患者撤机结局的预测价值。
纳入2018年1月至12月在东部战区总医院普通外科研究所和连云港市第一人民医院重症监护病房（ICU）接受机械通气的IAI患者。符合撤机标准的患者进入撤机流程，包括自主呼吸试验（SBT）和拔管。根据是否通过120分钟SBT将患者分为SBT成功组和SBT失败组。比较两组SBT前后的LUS评分。SBT成功组患者进行拔管，根据拔管后48小时内是否需要再次插管分为拔管成功组和拔管失败组进行亚组分析。比较拔管前（SBT结束时）和拔管后48小时（拔管成功组为拔管后48小时，拔管失败组为再次插管前）的LUS评分。绘制受试者工作特征（ROC）曲线，评估SBT前LUS评分对SBT失败的预测价值以及拔管前LUS评分对拔管失败的预测价值。
共纳入76例接受机械通气的IAI患者。排除23例机械通气时间小于48小时、重度慢性阻塞性肺疾病（COPD）、气管切开或自动出院的患者，纳入53例患者。9例患者SBT失败，44例患者SBT成功，其中23例患者拔管成功，21例患者拔管失败。SBT失败组SBT前后的LUS评分显著高于SBT成功组（SBT前：13.22±1.99 vs. 10.79±1.64，t = -3.911，P = 0.000；SBT后：19.00±1.12 vs. 13.41±1.86，t = -8.665，P = 0.000）。ROC曲线分析显示，SBT前LUS评分预测SBT失败的ROC曲线下面积（AUC）为0.82 [95%置信区间（95%CI）为0.67 - 0.98，P = 0.002]。当最佳截断值为12.5时，灵敏度为66.7%，特异度为84.1%。亚组分析显示，拔管失败组拔管前后的LUS评分显著高于拔管成功组（拔管前：14.19±1.60 vs. 12.69±1.81，t = -2.881，P = 0.006；拔管后：缉16.42±1.59 vs. 12.78±1.54，t = -7.710，P = 0.000）。ROC曲线分析显示，拔管前LUS评分预测拔管失败的AUC为0.81（95%CI为0.69 - 0.92，P = 0.000）。当最佳截断值为13.5时，灵敏度为80.0%，特异度为65.2%。
LUS评分可有效预测IAI接受机械通气患者的SBT结局及拔管后再次插管的风险。
