Demoule Alexandre, Fossé Quentin, Mercat Alain, Bergum Daniel, Virolle Sara, Bureau Côme, Mellemseter Marit, Guichou Rafaël, Similowski Thomas, Dres Martin, Mortaza Satar
Service de Médecine Intensive - Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651 Paris Cedex 13, 75013, Paris, France.
UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.
Crit Care. 2024 Jul 16;28(1):245. doi: 10.1186/s13054-024-05003-0.
In mechanically ventilated patients, diaphragm ultrasound can identify diaphragm weakness and predict weaning failure. We evaluated whether a novel operator-independent ultrasound-based medical device allowing continuous monitoring of the diaphragm (CUSdi) could reliably (1) measure diaphragm excursion (EXdi) and peak contraction velocity (PCVdi), (2) predict weaning outcome, and (3) approximate transdiaphragmatic pressure (Pdi).
In 49 mechanically ventilated patients, CUSdi was recorded during a 30-min spontaneous breathing trial (SBT), and EXdi and PCVdi were measured. In subgroups of patients, standard ultrasound measurement of EXdi and PCVdi was performed (n = 36), and Pdi derived parameters (peak and pressure time product, n = 30) were measured simultaneously.
The agreement bias between standard ultrasound and CUSdi for EXdi was 0.1 cm (95% confidence interval -0.7-0.9 cm). The regression of Passing-Bablok indicated a lack of systematic difference between EXdi measured with standard ultrasound and CUSdi, which were positively correlated (Rho = 0.84, p < 0.001). Weaning failure was observed in 54% of patients. One, two and three minutes after the onset of the SBT, EXdi was higher in the weaning success group than in the failure group. Two minutes after the onset of the SBT, an EXdi < 1.1 cm predicted weaning failure with a sensitivity of 0.83, a specificity of 0.68, a positive predictive value of 0.76, and a negative predictive value of 0.24. There was a weak correlation between EXdi and both peak Pdi (r = 0.22, 95% confidence interval 0.15 - 0.28) and pressure time product (r = 0.13, 95% confidence interval 0.06 - 0.20). Similar results were observed with PCVdi.
Operator-independent continuous diaphragm monitoring quantifies EXdi reliably and can predict weaning failure with an identified cut-off value of 1.1 cm. Trial registration clinicaltrial.gov, NCT04008875 (submitted 12 April 2019, posted 5 July 2019) and NCT03896048 (submitted 27 March 2019, posted 29 March 2019).
在机械通气患者中，膈肌超声可识别膈肌无力并预测撤机失败。我们评估了一种新型的基于超声的、无需操作员操作的医疗设备（CUSdi）能否可靠地（1）测量膈肌移动度（EXdi）和峰值收缩速度（PCVdi），（2）预测撤机结果，以及（3）估算跨膈压（Pdi）。
对49例机械通气患者在30分钟自主呼吸试验（SBT）期间记录CUSdi，并测量EXdi和PCVdi。在患者亚组中，进行EXdi和PCVdi的标准超声测量（n = 36），并同时测量Pdi衍生参数（峰值和压力时间乘积，n = 30）。
标准超声与CUSdi测量EXdi的一致性偏差为0.1厘米（95%置信区间-0.7至0.9厘米）。Passing-Bablok回归表明，标准超声测量的EXdi与CUSdi之间无系统差异，二者呈正相关（Rho = 0.84，p < 0.001）。54%的患者出现撤机失败。SBT开始后1分钟、2分钟和3分钟，撤机成功组的EXdi高于失败组。SBT开始后2分钟，EXdi < 1.1厘米预测撤机失败的灵敏度为0.83，特异度为0.68，阳性预测值为0.76，阴性预测值为0.24。EXdi与峰值Pdi（r = 0.22，95%置信区间0.15 - 0.28）和压力时间乘积（r = 0.13，95%置信区间0.06 - 0.20）之间均呈弱相关。PCVdi也观察到类似结果。
无需操作员操作的连续膈肌监测可可靠地量化EXdi，并能以确定的临界值1.1厘米预测撤机失败。试验注册 clinicaltrial.gov，NCT04008875（2019年4月12日提交，2019年7月5日发布）和NCT03896048（2019年3月27日提交，2019年3月29日发布）。
