超声膈肌运动评估预测心胸外科术后拔管失败：EXPEDIA 研究。

Extubation Failure Prediction by Echography of the Diaphragm After Cardiothoracic Surgery: The EXPEDIA Study.

机构信息

Department of Anesthesiology and Intensive Care, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Paris, France.

Department of Anesthesiology and Intensive Care, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Paris, France and University Paris Saclay Faculty of Medicine, Kremlin Bicêtre, France.

出版信息

Respir Care. 2022 Mar;67(3):308-315. doi: 10.4187/respcare.09476. Epub 2022 Jan 4.

DOI:10.4187/respcare.09476

PMID:34983832

Abstract

BACKGROUND

Successful extubation is difficult to predict. Ultrasound measurement of the diaphragm thickening fraction (DTF) might help predict weaning failure after cardiothoracic surgery.

METHODS

We assessed the predictive performance of diaphragm ultrasound in a derivation cohort of 50 prospectively included cardiothoracic surgery subjects ready for a weaning trial and in a validation cohort of 39 subjects ventilated for ≥ 48 h. DTF was assessed by ultrasound during pressure support ventilation (PSV) then during a T-piece spontaneous breathing trial (SBT). DTF was the percentage change in diaphragm thickness between expiration and inspiration and DTF, the higher DTF value of the 2 hemidiaphragms. DTF during SBT (static study) and the difference in DTF between PSV and SBT (dynamic study) were analyzed.

RESULTS

In the derivation cohort, DTF during SBT was 25.6 ± 17.3% in subjects with successful extubation and 65.2 ± 17.3% in those with weaning failure (difference 39.7 [95% CI 27.4-51.9], < .01). During SBT, DTF ≥ 50% was associated with weaning failure (area under the receiver operating characteristic curve [AUC] 0.94 ± 0.05). In the dynamic study, a ≥ 40% DTF increase was associated with weaning failure (AUC 0.91 ± 0.06). In the validation cohort, DTF during SBT was 20.3 ± 17.1% in subjects with successful extubation and 82.0 ± 51.6% in those with weaning failure (difference 61.8 [95% CI 41.6-82.0], < .01). During SBT, DTF ≥ 50% predicted weaning failure (AUC 0.99 ± 0.02). In the dynamic study, a ≥ 40% increase in DTF predicted weaning failure (AUC 0.81 ± 0.09).

CONCLUSIONS

Measuring DTF during SBT and the DTF change when switching from PSV to SBT may help predict weaning failure after cardiothoracic surgery. The study was registered on ANZCTR.

CLINICAL TRIAL REGISTRATION NUMBER

U1111-1180-1999.

摘要

背景

成功拔管难以预测。超声测量膈肌增厚分数（DTF）可能有助于预测心胸手术后脱机失败。

方法

我们评估了膈肌超声在 50 名接受心胸外科手术、准备脱机试验的前瞻性纳入患者的推导队列和 39 名接受通气>48 小时的验证队列中的预测性能。在压力支持通气（PSV）期间和 T 型管自主呼吸试验（SBT）期间通过超声评估 DTF。DTF 是呼气和吸气之间膈肌厚度的百分比变化，DTF 是两个半膈肌中较高的 DTF 值。分析了 SBT 期间的 DTF（静态研究）和 PSV 与 SBT 之间的 DTF 差异（动态研究）。

结果

在推导队列中，成功拔管患者的 SBT 期间 DTF 为 25.6±17.3%，脱机失败患者为 65.2±17.3%（差异 39.7[95%CI 27.4-51.9]，<.01）。在 SBT 期间，DTF≥50%与脱机失败相关（接受者操作特征曲线下面积[AUC]0.94±0.05）。在动态研究中，DTF 增加≥40%与脱机失败相关（AUC 0.91±0.06）。在验证队列中，成功拔管患者的 SBT 期间 DTF 为 20.3±17.1%，脱机失败患者为 82.0±51.6%（差异 61.8[95%CI 41.6-82.0]，<.01）。在 SBT 期间，DTF≥50%预测脱机失败（AUC 0.99±0.02）。在动态研究中，DTF 增加≥40%预测脱机失败（AUC 0.81±0.09）。