Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Respir Med. 2021 Aug-Sep;185:106503. doi: 10.1016/j.rmed.2021.106503. Epub 2021 Jun 12.
To determine whether baseline diaphragm (T), rectus femoris (RF) and vastus intermedius (VI) muscle thickness (T and T) are associated with weaning success.
Right T, T and T were measured by ultrasonography within 36 h of intubation and diaphragmatic excursion (DE) was evaluated at the first spontaneous breathing trial in adult critically-ill patients. Reintubation or death within 7 days after extubation was defined as weaning failure. Weaning failure and success groups were compared in terms of ultrasonographic measurements and clinical features.
Thirty-eight patients were assessed for weaning, 15 (39.4%) being in the weaning failure group. The median body mass index (BMI) was lower while the median clinical frailty scale (CFS), vasopressor use, duration of mechanical ventilation, intensive care and hospital mortality rate were higher in the weaning failure group, and the median T (14.0 [12.3-26.2] vs 23.6 [21.3-27.1] mm, p = 0.03) and median DE (19.4 [14.6-24.0] vs 25.9 [19.3-38.5] mm, p = 0.045) were lower. The median T was similar in two groups (1.9 [1.5-2.3] vs 2.0 [1.7-2.4] mm, p = 0.26). In ROC analysis, area under the curve for T was 0.71 (95% CI: 0.51-0.90; p = 0.035), with 21 mm cut-off having sensitivity of 82% and specificity of 57%. Binary logistic regression analysis revealed T < 21 mm as the only predictor of weaning failure with an odds ratio of 10.5 (95% CI: 1.1-97.8, p = 0.038) after adjusting for age, sex, BMI and CFS.
T lower than 21 mm, measured by ultrasonography within 36 h of intubation, was associated with weaning failure among critically-ill patients.
为了确定基线膈肌（T）、股直肌（RF）和股中间肌（VI）厚度（T 和 T）是否与撤机成功相关。
在气管插管后 36 小时内通过超声测量右 T、T 和 T，在成人危重病患者第一次自主呼吸试验时评估膈肌活动度（DE）。拔管后 7 天内重新插管或死亡定义为撤机失败。比较撤机成功组和撤机失败组的超声测量和临床特征。
对 38 例患者进行撤机评估，其中 15 例（39.4%）为撤机失败组。撤机失败组的中位体重指数（BMI）较低，临床虚弱评分（CFS）、血管加压素使用、机械通气时间、重症监护和住院死亡率较高，T 中位数（14.0[12.3-26.2]vs23.6[21.3-27.1]mm，p=0.03）和 DE 中位数（19.4[14.6-24.0]vs25.9[19.3-38.5]mm，p=0.045）较低。两组 T 中位数相似（1.9[1.5-2.3]vs2.0[1.7-2.4]mm，p=0.26）。ROC 分析显示，T 的曲线下面积为 0.71（95%CI：0.51-0.90；p=0.035），21mm 截断值的敏感性为 82%，特异性为 57%。二元逻辑回归分析显示，T<21mm 是撤机失败的唯一预测因素，调整年龄、性别、BMI 和 CFS 后，比值比为 10.5（95%CI：1.1-97.8，p=0.038）。
气管插管后 36 小时内通过超声测量的 T 值低于 21mm 与危重病患者撤机失败相关。
