Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Ramathibodi Hospital, Rama VI Road, Bangkok, 10400, Ratchathewi, Thailand.
Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Ramathibodi Hospital, Rama VI Road, Bangkok, 10400, Ratchathewi, Thailand.
BMC Pulm Med. 2023 Apr 4;23(1):109. doi: 10.1186/s12890-023-02392-w.
Several parameters are used to predict successful extubation but their accuracy varies among studies. We hypothesized that combining conventional and diaphragmatic parameters would be more effective than using just one. Our primary objective was to evaluate the performance of the respiratory rate in relation to the diaphragm thickening fraction (RR/DTF) ratio to predict the success of extubation.
We enrolled 130 adult patients who required invasive mechanical ventilation, planned to be extubated, and used a spontaneous breathing trial (SBT) in the intensive care unit from July 2020 to April 2022. We measured the conventional parameters and the diaphragmatic parameters 2 h after SBT. The RR/DTF was calculated by dividing the respiratory rate (RR) by the diaphragm thickening fraction (DTF). The definition of weaning success is successful extubation within 48 h.
Of 130 patients, 8 patients (6.2%) were reintubated within 48 h. The RR/DTF was significantly lower in the successful extubation group than in the extubation failure group (right hemidiaphragm; 0.47 (0.33-0.64) vs 1.1 (0.6-2.32), p < 0.001 and left hemidiaphragm; 0.45 (0.31-0.65) vs 0.78 (0.48-1.75), p < 0.001). The right RR/DTF using a cut-off point at ≤ 0.81 had a sensitivity of 87.7%, a specificity of 75%, and areas under the receiver operating characteristic curve (AUROC) of 0.762 for predicting successful extubation (p = 0.013). The sensitivity, specificity, and AUROC for predicting extubation success of right DTF at a cut-off point of ≥ 26.2% were 84.3%, 62.5%, and 0.775, respectively (p = 0.009).
The RR/DTF ratio is a promising tool for predicting extubation outcome. Additionally, using RR/DTF was more reliable than conventional or diaphragmatic parameters alone in predicting extubation success.
有几个参数用于预测拔管成功，但它们在不同研究中的准确性不同。我们假设结合常规和膈肌参数会比仅使用一个参数更有效。我们的主要目的是评估呼吸频率与膈肌增厚分数（RR/DFT）比值与预测拔管成功的关系。
我们纳入了 2020 年 7 月至 2022 年 4 月在重症监护病房接受有创机械通气、计划行自主呼吸试验（SBT）且需要拔管的 130 例成年患者。我们在 SBT 后 2 小时测量常规参数和膈肌参数。RR/DFT 通过呼吸频率（RR）除以膈肌增厚分数（DTF）计算得出。拔管成功的定义是在 48 小时内成功拔管。
在 130 例患者中，有 8 例（6.2%）在 48 小时内重新插管。成功拔管组的 RR/DFT 明显低于拔管失败组（右侧膈肌：0.47（0.33-0.64）比 1.1（0.6-2.32），p<0.001；左侧膈肌：0.45（0.31-0.65）比 0.78（0.48-1.75），p<0.001）。右侧 RR/DFT 使用截断值≤0.81 时，预测拔管成功的灵敏度为 87.7%，特异性为 75%，受试者工作特征曲线（ROC）下面积（AUROC）为 0.762（p=0.013）。右侧 DTF 截断值≥26.2%时，预测拔管成功的灵敏度、特异性和 AUROC 分别为 84.3%、62.5%和 0.775（p=0.009）。
RR/DFT 比值是预测拔管结果的有前途的工具。此外，与单独使用常规或膈肌参数相比，RR/DFT 更可靠地预测拔管成功。
