Xu Qiancheng, Yang Xiao, Qian Yan, Hu Chang, Lu Weihua, Cai Shuhan, Li Jianguo, Hu Bo
Department of Emergency Intensive Care Unit, Wuhu Hospital, East China Normal University, Wuhu, Anhui, China.
Shock. 2023 Jan 1;59(1):66-73. doi: 10.1097/SHK.0000000000002044. Epub 2022 Nov 16.
Background: The purpose of this study was to determine the feasibility, reliability, and reproducibility of parasternal intercostal muscle longitudinal strain (LSim) quantification by speckle tracking and the value of maximal LSim to predict weaning outcomes. Methods: This study was divided into three phases. Phases 1 and 2 comprehended prospective observational programs to evaluate the feasibility, reliability, and repeatability of speckle tracking to assess LSim in healthy subjects and mechanically ventilated patients. Phase 3 was a multicenter retrospective study to evaluate the value of maximal LSim, intercostal muscle thickening fraction (TFim), diaphragmatic thickening fraction, diaphragmatic excursion, and rapid shallow breathing index to predict weaning outcomes. Results: A total of 25 healthy subjects and 20 mechanically ventilated patients were enrolled in phases 1 and 2, respectively. Maximal LSim was easily accessible, and the intraoperator reliability and interoperator reliability were excellent in eupnea, deep breathing, and mechanical ventilation. The intraclass correlation coefficient ranged from 0.85 to 0.96. Moreover, 83 patients were included in phase 3. The areas under the receiver operating characteristic curve of maximal LSim, TFim, diaphragmatic thickening fraction, diaphragmatic excursion, and rapid shallow breathing index were 0.91, 0.79, 0.71, 0.70, and 0.78 for the prediction of successful weaning, respectively. The best cutoff values of LSim and TFim were >-6% (sensitivity, 100%; specificity, 64.71%) and <7.6% (sensitivity, 100%; specificity, 50.98%), respectively. Conclusions: The quantification of LSim by speckle tracking was easily achievable in healthy subjects and mechanically ventilated patients and presented a higher predictive value for weaning success compared with conventional weaning parameters. Trial registration no. ChiCTR2100049817.
本研究旨在确定通过斑点追踪技术测量胸骨旁肋间肌纵向应变（LSim）的可行性、可靠性和可重复性，以及最大LSim对预测撤机结果的价值。方法：本研究分为三个阶段。第1阶段和第2阶段为前瞻性观察项目，以评估斑点追踪技术在健康受试者和机械通气患者中评估LSim的可行性、可靠性和可重复性。第3阶段为多中心回顾性研究，以评估最大LSim、肋间肌增厚分数（TFim）、膈肌增厚分数、膈肌移动度和快速浅呼吸指数对预测撤机结果的价值。结果：第1阶段和第2阶段分别纳入了25名健康受试者和20名机械通气患者。最大LSim易于获取，在平静呼吸、深呼吸和机械通气状态下，操作者内可靠性和操作者间可靠性均极佳。组内相关系数范围为0.85至0.96。此外，第3阶段纳入了83例患者。最大LSim、TFim、膈肌增厚分数、膈肌移动度和快速浅呼吸指数预测成功撤机的受试者工作特征曲线下面积分别为0.91、0.79、0.71、0.70和0.78。LSim和TFim的最佳截断值分别为>-6%（敏感性，100%；特异性，64.71%）和<7.6%（敏感性，100%；特异性，50.98%）。结论：在健康受试者和机械通气患者中，通过斑点追踪技术量化LSim易于实现，与传统撤机参数相比，其对撤机成功具有更高的预测价值。试验注册号：ChiCTR2100049817。
