Lalwani Lokesh Kumar, Govindagoudar Manjunath B, Singh Pawan Kumar, Sharma Mukesh, Chaudhry Dhruva
Department of Tuberculosis and Respiratory Medicine, Post Graduate Institute of Medical Sciences, Rohtak, India.
Department of Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences, Rohtak, India.
Acute Crit Care. 2022 Aug;37(3):347-354. doi: 10.4266/acc.2022.00108. Epub 2022 Jul 25.
Acute respiratory failure (ARF) is commonly managed with invasive mechanical ventilation (IMV). The majority of the time that a patient spends on IMV is in the process of weaning. Prediction of the weaning outcome is of paramount importance, as untimely/delayed extubation is associated with a high risk of mortality. Diaphragmatic ultrasonography is a promising tool in the intensive care unit, and its utility in predicting the success of weaning remains understudied.
In this prospective-observational study, we recruited 54 ARF patients on IMV, along with 50 healthy controls. During a spontaneous breathing trial, all subjects underwent diaphragmatic ultrasonography along with a rapid shallow breathing index (RSBI) assessment.
The mean age was 41.8±17.0 and 37.6±10.5 years among the cases and control group, respectively. Demographic variables were broadly similar in the two groups. The most common cause of ARF was obstructive airway disease. The average duration of IMV was 5.41±2.81 days. Out of 54 subjects, 45 were successfully weaned, while nine patients failed weaning. Age, body mass index, and severity of disease were similar in the successful and failed weaning patients. The sensitivity in predicting successful weaning of percent change in diaphragmatic thickness (Δtdi%) >29.71% was high (93.33%), while specificity was 66.67%. The sensitivity and specificity of mean diaphragmatic thickness (tdi) end-expiratory >0.178 cm was 60.00% and 77.78%, respectively. RSBI at 1 minute of <93.75 had an equally high sensitivity (93.33%) but a lower specificity (22.22%). Similar results were also found for RSBI measured at 5 minutes.
During the weaning assessment, the purpose is to minimize both premature as well as delayed extubation. We found that diaphragmatic ultrasonography, in particular Δtdi%, is better than RSBI in predicting weaning outcomes.
急性呼吸衰竭（ARF）通常采用有创机械通气（IMV）进行治疗。患者接受IMV治疗的大部分时间都处于撤机过程中。预测撤机结果至关重要，因为过早/延迟拔管与高死亡风险相关。膈肌超声检查是重症监护病房中一种很有前景的工具，但其在预测撤机成功方面的效用仍研究不足。
在这项前瞻性观察研究中，我们招募了54例接受IMV治疗的ARF患者以及50名健康对照者。在自主呼吸试验期间，所有受试者均接受了膈肌超声检查以及快速浅呼吸指数（RSBI）评估。
病例组和对照组的平均年龄分别为41.8±17.0岁和37.6±10.5岁。两组的人口统计学变量大致相似。ARF最常见的病因是阻塞性气道疾病。IMV的平均持续时间为5.41±2.81天。54名受试者中，45人成功撤机，9人撤机失败。成功和失败撤机患者的年龄、体重指数和疾病严重程度相似。预测撤机成功时膈肌厚度变化百分比（Δtdi%）>29.71%的敏感性较高（93.33%），而特异性为66.67%。呼气末平均膈肌厚度（tdi）>0.178 cm的敏感性和特异性分别为60.00%和77.78%。1分钟时RSBI<93.75具有同样高的敏感性（93.33%）但特异性较低（22.22%）。5分钟时测量的RSBI也得到了类似结果。
在撤机评估期间，目的是尽量减少过早和延迟拔管。我们发现，膈肌超声检查，尤其是Δtdi%，在预测撤机结果方面优于RSBI。
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