胸骨旁肋间肌增厚分数与膈肌增厚分数比值预测撤机失败。

The ratio of parasternal intercostal muscle-thickening fraction-to-diaphragm thickening fraction for predicting weaning failure.

机构信息

Department of Critical Care Medicine, Hebei Medical University, Shijiazhuang 050000, Hebei, China; Department of Intensive Care Unit, Hebei General Hospital, Shijiazhuang 050000, Hebei, China; Department of Intensive Care Unit, Harrison International Peace Hospital, Hengshui 053000, Hebei, China.

Department of Intensive Care Unit, Harrison International Peace Hospital, Hengshui 053000, Hebei, China.

出版信息

J Crit Care. 2024 Oct;83:154847. doi: 10.1016/j.jcrc.2024.154847. Epub 2024 Jun 22.

DOI:10.1016/j.jcrc.2024.154847

PMID:38909540

Abstract

BACKGROUND

Diaphragm dysfunction is associated with weaning outcomes in mechanical ventilation patients, in the case of diaphragm dysfunction, the accessory respiratory muscles would be recruited. The main purpose of this study is to explore the performance of parasternal intercostal muscle thickening fraction in relation to diaphragmatic thickening fraction ratio (TFic/TFdi) for predicting weaning outcomes, and compare its accuracy with D-RSBI in predicting weaning failure.

MATERIALS AND METHODS

We prospectively enrolled consecutive patients from 7/2022-5/2023. We measured TFic, TFdi, and diaphragmatic excursion (DE) by ultrasound and calculated the TFic/TFdi ratio and diaphragmatic rapid shallow breathing index (D-RSBI). Receiver-operator characteristic (ROC) curves evaluated the accuracy of the TFic/TFdi ratio and D-RSBI in predicting weaning failure.

RESULTS

161 were included in the final analysis, 114 patients (70.8%) were successfully weaned from mechanical ventilation. The TFic/TFdi ratio (AUROC = 0.887 (95% CI: 0.821-0.953)) was superior to the D-RSBI (AUROC = 0.875 (95% CI: 0.807-0.944)) for predicting weaning failure.

CONCLUSIONS

The TFic/TFdi ratio predicted weaning failure with high accuracy and outperformed the D-RSBI.

摘要

背景

膈肌功能障碍与机械通气患者的撤机结局相关，在膈肌功能障碍的情况下，辅助呼吸肌将被募集。本研究的主要目的是探讨胸骨旁肋间肌增厚分数（TFic）与膈肌增厚分数比（TFic/TFdi）在预测撤机结局方面的表现，并比较其与 D-RSBI 在预测撤机失败方面的准确性。

材料和方法

我们前瞻性地纳入了 2022 年 7 月至 2023 年 5 月连续的患者。我们通过超声测量 TFic、TFdi 和膈肌活动度（DE），计算 TFic/TFdi 比值和膈肌快速浅呼吸指数（D-RSBI）。接受者操作特征（ROC）曲线评估了 TFic/TFdi 比值和 D-RSBI 预测撤机失败的准确性。