Zhang Tianjie, Liu Yan, Xu Dongwei, Dong Rui, Song Ye
Department of Ultrasonography, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318,People's Republic of China.
Department of Critical Care Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, People's Republic of China.
Int J Gen Med. 2024 Nov 18;17:5373-5380. doi: 10.2147/IJGM.S487999. eCollection 2024.
This study aims to evaluate the predictive value of bedside ultrasound evaluation of diaphragmatic dynamics in determining successful extubation outcomes for patients eligible for weaning.
This prospective observational study was conducted on patients who were mechanically ventilated and ready for weaning during the spontaneous breathing trial (SBT). The diaphragm contraction and motion-related parameters of patients such as end inspiratory diaphragm thickness (DT-insp), end respiratory diaphragm thickness (DT-exp), diaphragm thickening fraction (DTF), diaphragmatic thickening fraction rapid shallow breathing index (DTF-RSBI), diaphragmatic excursion (DE), diaphragmatic excursion rapid shallow breathing index (DE-RSBI) were recorded and the association with failure in ventilatory extubation was analyzed. A receiver operating characteristic (ROC) curve was conducted to analyze the prediction of successful weaning.
Out of 95 patients, 14 (14.74%) died, and 68 (71.58%) were successfully extubated. There were significant differences between the two groups in all parameters except DT-exp. The results indicated that duration of mechanical ventilation (OR = 0.850, 95% CI: 0.770-0.938, P = 0.001), DTF (OR = 1.214, 95% CI: 1.108-1.330, P = 0.000), DTF-RSBI (OR = 0.917, 95% CI: 0.880-0.954, P = 0.000), DE (OR = 127.02, 95% CI: 15.004-1075.291, P = 0.000), DE-RSBI (OR = 0.752, 95% CI: 0.657-0.861, P = 0.000) had predictive value for weaning. DTF and DE had a high sensitivity of 91.18%, 100%, respectively. Whereas, duration of mechanical ventilation, DTF-RSBI, DE-RSBI showed a high specificity of 81.48,85.19%, 81.48%. Considering all the above factors, the sensitivity was 88.24% and the specificity was 88.89%.
Bedside ultrasound assessment of diaphragmatic parameters enables the detection of diaphragmatic dysfunction, thus proving valuable in predicting extubation success and facilitating a favorable weaning outcome.
本研究旨在评估床旁超声评估膈肌动力学对有撤机指征患者成功拔管结局的预测价值。
本前瞻性观察性研究针对在自主呼吸试验（SBT）期间接受机械通气且准备撤机的患者进行。记录患者的膈肌收缩及运动相关参数，如吸气末膈肌厚度（DT - insp）、呼气末膈肌厚度（DT - exp）、膈肌增厚分数（DTF）、膈肌增厚分数快速浅呼吸指数（DTF - RSBI）、膈肌移动度（DE）、膈肌移动度快速浅呼吸指数（DE - RSBI），并分析其与通气撤机失败的相关性。绘制受试者工作特征（ROC）曲线以分析成功撤机的预测情况。
95例患者中，14例（14.74%）死亡，68例（71.58%）成功拔管。除DT - exp外，两组在所有参数上均存在显著差异。结果表明，机械通气时间（OR = 0.850，95%CI：0.770 - 0.938，P = 0.001）、DTF（OR = 1.214，95%CI：1.108 - 1.330，P = 0.000）、DTF - RSBI（OR = 0.917，95%CI：0.880 - 0.954，P = 0.000）、DE（OR = 127.02，95%CI：15.004 - 1075.291，P = 0.000）、DE - RSBI（OR = 0.752，95%CI：0.657 - 0.861，P = 0.000）对撤机具有预测价值。DTF和DE的敏感性分别高达91.18%、100%。而机械通气时间、DTF - RSBI、DE - RSBI的特异性分别为81.48%、85.19%、81.48%。综合上述所有因素，敏感性为88.24%，特异性为88.89%。
床旁超声评估膈肌参数能够检测膈肌功能障碍，从而在预测拔管成功及促进良好的撤机结局方面具有重要价值。
