Department of Respiratory and Critical Care Medicine, Beijing Haidian Hospital, No. 29, Zhongguancun St, Haidian District, Beijing, 100080, China.
BMC Pulm Med. 2021 Jul 9;21(1):217. doi: 10.1186/s12890-021-01605-4.
With the increased ageing of society, more and more elderly people are admitted to the intensive care unit, How to accurately predict whether elderly patients can successfully wean from the ventilator is more complicated. Diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF) were measured by bedside ultrasound to assess diaphragm function. The lung ultrasound score (LUS) and the rapid shallow breathing index (RBSI) were used as indices of diaphragm function to predict the outcome of weaning from mechanical ventilation. The aim of this study was to examine the clinical utility of these parameters in predicting extubation success.
This prospective study included 101 consecutive elderly patients undergoing a trial of extubation in the ICU of Haidian Hospital between June 2017 and July 2020. Patients were divided into the successful weaning group (n = 69) and the failed weaning group (n = 32). Baseline characteristics, including RSBI, were recorded. Measurements of DE, DTF and LUS were made using ultrasound within 24 h before extubation.
Median DE was greater in patients with extubation success than in those with extubation failure (1.64 cm vs. 0.78 cm, p = 0.001). Patients with extubation success had a greater DTF than those with extubation failure (49.48% vs. 27.85%, p = 0.001). The areas under the receiver operating curves for the RSBI, LUS, DE and DFT were 0.680, 0.764, 0.831 and 0.881, respectively. The best cut-off values for predicting successful weaning were DTF ≥ 30%, DE ≥ 1.3 cm, LUS ≤ 11, and RSBI ≤ 102. The specificity of DTF (84%) in predicting weaning outcome was higher than that of RBSI (53%), that of LUS (55%), and that of DE (62%). The sensitivity of DTF (94%) was greater than that of RBSI (85%), that of LUS (71%), and that of DE (65%). The combination of RSBI, LUS, DE, and DTF showed the highest AUC (AUC = 0.919), with a sensitivity of 96% and a specificity of 89%.
DTF has higher sensitivity and specificity for the prediction of successful weaning in elderly patients than the other parameters examined. The combination of RSBI, LUS, DE and DFT performed well in predicting weaning outcome. This has potentially important clinical application and merits further evaluation.
随着社会老龄化的加剧，越来越多的老年人被收入重症监护病房，如何准确预测老年患者能否成功脱离呼吸机变得更加复杂。通过床旁超声测量膈肌活动度（DE）和膈肌增厚分数（DTF）来评估膈肌功能。肺超声评分（LUS）和快速浅呼吸指数（RBSI）被用作预测机械通气脱机结局的膈肌功能指标。本研究旨在探讨这些参数在预测拔管成功中的临床应用价值。
这是一项前瞻性研究，纳入了 2017 年 6 月至 2020 年 7 月期间在海淀医院 ICU 接受脱机试验的 101 例连续老年患者。患者分为成功脱机组（n=69）和脱机失败组（n=32）。记录 RBSI 等基线特征。在脱机前 24 小时内使用超声测量 DE、DTF 和 LUS。
与脱机失败组相比，成功脱机组的 DE 更大（1.64cm 比 0.78cm，p=0.001）。成功脱机组的 DTF 大于脱机失败组（49.48%比 27.85%，p=0.001）。RBSI、LUS、DE 和 DTF 的受试者工作特征曲线下面积分别为 0.680、0.764、0.831 和 0.881。预测成功脱机的最佳截断值分别为 DTF≥30%、DE≥1.3cm、LUS≤11、RBSI≤102。DTF（84%）预测拔管结局的特异性高于 RBSI（53%）、LUS（55%）和 DE（62%）。DTF（94%）的灵敏度高于 RBSI（85%）、LUS（71%）和 DE（65%）。RSBI、LUS、DE 和 DTF 的联合应用显示出最高的 AUC（AUC=0.919），其灵敏度为 96%，特异性为 89%。
与其他检查参数相比，DTF 对老年患者成功脱机的预测具有更高的灵敏度和特异性。RSBI、LUS、DE 和 DTF 的联合应用在预测脱机结局方面表现良好。这具有潜在的重要临床应用价值，值得进一步评估。
