Gok Funda, Mercan Aysel, Kilicaslan Alper, Sarkilar Gamze, Yosunkaya Alper
Department of Critical Care Medicine, Necmettin Erbakan University, Meram School of Medicine, Konya, TUR.
Department of Anesthesiology and Reanimation, Necmettin Erbakan University, Meram School of Medicine, Konya, TUR.
Cureus. 2021 May 16;13(5):e15057. doi: 10.7759/cureus.15057.
Optimum timing is crucial to avoid negative outcomes of weaning. We aimed to investigate predictive values of diaphragmatic thickening fraction (DTF), diaphragmatic excursion (DE), and anterolateral lung ultrasound (LUS) scores in extubation success and compare with rapid shallow breathing index (RSBI) in patients extubated under traditional parameters.
Patients undergoing mechanical ventilation for >48 hours were included in the study. In patients planned for extubation, sonographic evaluations of the diaphragm and lung were performed at the T-tube stage. RSBI was achieved in the pressure support (PS) ventilation stage. Predictive values of DTF, DE, and anterolateral LUS scores were compared with RSBI in extubation success.
Sixty-two patients were enrolled in the study. The study population consisted mostly of trauma patients (77%). A cut-off value of 64 was obtained for RSBI. The positive predictive value (PPV) was found at 97% in extubation success. Cut-off values of 27.5 for DTF, 1.3 cm for the DE, and 6.5 for LUS scores were obtained at the T-tube stage, respectively. PPVs of all sonographic parameters were found over 90%. At the first stage, weaning and extubation failures were determined as 35 and 9.6%, respectively. RSBI was found as a powerful parameter in determining extubation success (r=0.774, p≤0.001) and moderately correlated with sonographic parameters.
Investigating the lung and diaphragm via ultrasound provides real-time information to increase extubation success. Cut-off values of 64 for RSBI, 27.5 for DTF, 1.3 cm for the DE, and 6.5 for LUS scores were obtained, respectively, and PPVs of all sonographic parameters were found over 90%. We consider that sonographic evaluations accompanied by an RSBI will increase extubation success in the weaning process.
最佳时机对于避免撤机的不良后果至关重要。我们旨在研究膈肌增厚分数（DTF）、膈肌移动度（DE）和前外侧肺部超声（LUS）评分对拔管成功的预测价值，并与在传统参数下拔管患者的快速浅呼吸指数（RSBI）进行比较。
纳入接受机械通气超过48小时的患者。对于计划拔管的患者，在T管阶段对膈肌和肺部进行超声评估。在压力支持（PS）通气阶段计算RSBI。比较DTF、DE和前外侧LUS评分与RSBI对拔管成功的预测价值。
62例患者纳入研究。研究人群主要为创伤患者（77%）。RSBI的截断值为64。拔管成功时的阳性预测值（PPV）为97%。在T管阶段，DTF的截断值为27.5，DE为1.3 cm，LUS评分为6.5。所有超声参数的PPV均超过90%。在第一阶段，撤机失败和拔管失败分别为35%和9.6%。RSBI是决定拔管成功的有力参数（r = 0.774，p≤0.001），且与超声参数中度相关。
通过超声检查肺部和膈肌可提供实时信息以提高拔管成功率。分别获得了RSBI的截断值为64、DTF为27.5、DE为1.3 cm、LUS评分为6.5，且所有超声参数的PPV均超过90%。我们认为，在撤机过程中，RSBI辅助的超声评估将提高拔管成功率。
