Laguado-Nieto Marlon Adrián, Roberto-Avilán Sandra Liliana, Naranjo-Junoy Francisco, Meléndez-Flórez Héctor Julio, Lozada-Martinez Ivan David, Domínguez-Alvarado Gonzalo Andrés, Campos-Castillo Víctor Alfonso, Ríos-Orozco Sergio Uriel, Narváez-Rojas Alexis Rafael
Department of Critical Medicine and Intensive Care, FOSCAL International Clinic, Bucaramanga, Colombia.
Department of Radiology and Diagnostic Imaging, FOSCAL International Clinic, Bucaramanga, Colombia.
Clin Med Insights Circ Respir Pulm Med. 2023 Mar 27;17:11795484231165940. doi: 10.1177/11795484231165940. eCollection 2023.
A frequent cause of weaning and extubation failure in critically ill mechanically ventilated patients is diaphragm muscle dysfunction. Ultrasound (US) evaluation of the diaphragm yields important data regarding its thickness (diaphragm thickening fraction [TFdi]) and its movement or excursion (diaphragmatic dynamics) that reveal the presence of diaphragmatic dysfunction.
Cross-sectional study, which included patients older than 18 years with invasive mechanical ventilation with an expected duration of more than 48 h, in a tertiary referral center in Colombia. The excursion of the diaphragm, inspiratory and expiratory thickness, and TFdi were evaluated by US. Prevalence and use of medications were evaluated, and the association with failure in ventilatory weaning and extubation was analyzed.
Sixty-one patients were included. The median age and APACHE IV score were 62.42 years and 78.23, respectively. The prevalence of diaphragmatic dysfunction (assessed by excursion and TFdi) was 40.98%. The sensibility, specificity, positive predictive value, and negative predictive value for TFdi < 20% was 86%, 24%, 75%, and 40%, respectively, with an area under the receiver operating characteristic (ROC) curve of 0.6. The ultrasonographic analysis of excursion of the diaphragm, inspiratory and expiratory thickness, and TFdi (>20%) allow in its set and with normal values, predict success or failure for the extubation with an area under the ROC curve of 0.87.
Diaphragmatic dynamics and thickness parameters together assessed by ultrasonography could predict the success of extubation in critically ill patients in Colombia, based on the finding of diaphragmatic dysfunction.
在重症机械通气患者中，撤机和拔管失败的常见原因是膈肌功能障碍。超声（US）对膈肌的评估可提供有关其厚度（膈肌增厚分数[TFdi]）及其运动或偏移（膈肌动力学）的重要数据，这些数据可揭示膈肌功能障碍的存在。
这是一项横断面研究，纳入了哥伦比亚一家三级转诊中心年龄超过18岁、预计有创机械通气时间超过48小时的患者。通过超声评估膈肌的偏移、吸气和呼气时的厚度以及TFdi。评估药物的使用情况，并分析其与通气撤机和拔管失败的相关性。
共纳入61例患者。中位年龄和急性生理与慢性健康状况评分系统IV（APACHE IV）评分分别为62.42岁和78.23。膈肌功能障碍（通过偏移和TFdi评估）的患病率为40.98%。TFdi<20%时的敏感性、特异性、阳性预测值和阴性预测值分别为86%、24%、75%和40%，受试者工作特征（ROC）曲线下面积为0.6。对膈肌偏移、吸气和呼气时厚度以及TFdi（>20%）的超声分析，结合其正常数值，可预测拔管的成功或失败，ROC曲线下面积为0.87。
基于膈肌功能障碍的发现，通过超声联合评估膈肌动力学和厚度参数可预测哥伦比亚重症患者拔管的成功与否。
