Song Jia, Luo Qiancheng, Lai Xinle, Hu Weihang, Yu Yihua, Wang Minjia, Yang Kai, Chen Gongze, Chen Wenwei, Li Qian, Hu Caibao, Gong Shijin
Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China.
Department of Critical Care Medicine, Shanghai Pudong New Area Gongli Hospital, No. 219, Miaopu Road, Pudong New Area, Shanghai, 200135, China.
Ann Intensive Care. 2024 Apr 20;14(1):60. doi: 10.1186/s13613-024-01294-2.
Weaning from invasive mechanical ventilation (MV) is a complex and challenging process that involves multiple pathophysiological mechanisms. A combined ultrasound evaluation of the heart, lungs, and diaphragm during the weaning phase can help to identify risk factors and underlying mechanisms for weaning failure. This study aimed to investigate the accuracy of lung ultrasound (LUS), transthoracic echocardiography (TTE), and diaphragm ultrasound for predicting weaning failure in critically ill patients.
Patients undergoing invasive MV for > 48 h and who were readied for their first spontaneous breathing trial (SBT) were studied. Patients were scheduled for a 2-h SBT using low-level pressure support ventilation. LUS and TTE were performed prospectively before and 30 min after starting the SBT, and diaphragm ultrasound was only performed 30 min after starting the SBT. Weaning failure was defined as failure of SBT, re-intubation, or non-invasive ventilation within 48 h.
Fifty-one patients were included, of whom 15 experienced weaning failure. During the SBT, the global, anterior, and antero-lateral LUS scores were higher in the failed group than in the successful group. Receiver operating characteristic curve analysis showed that the areas under the curves for diaphragm thickening fraction (DTF) and global and antero-lateral LUS scores during the SBT to predict weaning failure were 0.678, 0.719, and 0.721, respectively. There was no correlation between the LUS scores and the average E/e' ratio during the SBT. Multivariate analysis identified antero-lateral LUS score > 7 and DTF < 31% during the SBT as independent predictors of weaning failure.
LUS and diaphragm ultrasound can help to predict weaning failure in patients undergoing an SBT with low-level pressure support. An antero-lateral LUS score > 7 and DTF < 31% during the SBT were associated with weaning failure.
有创机械通气（MV）撤机是一个复杂且具有挑战性的过程，涉及多种病理生理机制。在撤机阶段对心脏、肺部和膈肌进行联合超声评估有助于识别撤机失败的风险因素及潜在机制。本研究旨在探讨肺部超声（LUS）、经胸超声心动图（TTE）和膈肌超声预测危重症患者撤机失败的准确性。
对接受有创MV超过48小时且准备进行首次自主呼吸试验（SBT）的患者进行研究。患者使用低水平压力支持通气进行为期2小时的SBT。前瞻性地在SBT开始前及开始后30分钟进行LUS和TTE检查，膈肌超声仅在SBT开始后30分钟进行。撤机失败定义为SBT失败、重新插管或在48小时内进行无创通气。
纳入51例患者，其中15例撤机失败。在SBT期间，失败组的整体、前侧和前外侧LUS评分高于成功组。受试者工作特征曲线分析显示，SBT期间膈肌增厚分数（DTF）以及整体和前外侧LUS评分预测撤机失败的曲线下面积分别为0.678、0.719和0.721。SBT期间LUS评分与平均E/e'比值之间无相关性。多因素分析确定SBT期间前外侧LUS评分>7和DTF<31%是撤机失败的独立预测因素。
LUS和膈肌超声有助于预测接受低水平压力支持SBT患者的撤机失败。SBT期间前外侧LUS评分>7和DTF<31%与撤机失败相关。
Zotero 插件
