Kumbhar Prathmesh G, Tejpal Manvinder, Karna Sunaina T, Singh Pooja, Saigal Saurabh, Waindeskar Vaishali
Department of Anesthesiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh.
Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Madhya Pradesh.
Monaldi Arch Chest Dis. 2025 Aug 7. doi: 10.4081/monaldi.2025.3548.
Weaning from invasive mechanical ventilation is difficult in critically ill patients, with diaphragmatic dysfunction being a key factor. This prospective observational study aimed to estimate key sonographic diaphragmatic parameters-thickness, thickening fraction, and excursion-in critically ill patients needing invasive mechanical ventilation and evaluate their association with weaning from mechanical ventilation. Over 18 months, adult patients needing mechanical ventilation were studied in a tertiary care hospital's medical intensive care unit. Besides the demographic and clinical parameters, the sonographic diaphragmatic thickness, thickening fraction, and excursion (DE) were measured via ultrasound at two points: before intubation and at the first spontaneous breathing trial. Patients were followed for 28 days after recruitment in the study to determine weaning outcomes, which were classified as simple or complicated (which included both difficult and prolonged). The baseline diaphragmatic parameters were compared between the outcome groups to determine clinically significant predictors of simple weaning. Out of the 70 patients enrolled in the study, final analysis was possible for 50 of them. Weaning was simple and complicated in 30 and 20 patients, respectively. DE was significant in predicting simple versus complicated weaning (p<0.001). The receiver operating characteristic curve displayed the cut-off of 10.5 mm with an area under the curve of 0.986 (95% confidence interval: 0.903-1.000), with p<0.0001. The test demonstrated a sensitivity of 96.77% and a specificity of 100%. Patients with pre-intubation DE<10.5 mm needed more days for weaning [median (interquartile) range of 8 (7-40)] and intensive care [16.50 (10-50)] as compared to those with DE>10.5 mm [4 (2-40)] and 8.50 (5-52)], which was significant with p<0.001. In conclusion, pre-intubation sonographic DE of less than 10.5 mm can effectively predict complicated weaning and may be an adjunct in prognostication.
在重症患者中，撤离有创机械通气很困难，其中膈肌功能障碍是一个关键因素。这项前瞻性观察性研究旨在评估需要有创机械通气的重症患者的关键超声膈肌参数——厚度、增厚率和移动度，并评估它们与机械通气撤离的相关性。在18个月的时间里，在一家三级护理医院的医学重症监护病房对需要机械通气的成年患者进行了研究。除了人口统计学和临床参数外，在两个时间点通过超声测量膈肌厚度、增厚率和移动度（DE）：插管前和首次自主呼吸试验时。在研究中招募患者后随访28天以确定撤离结果，撤离结果分为简单或复杂（包括困难和延长撤离）。比较结果组之间的基线膈肌参数，以确定简单撤离的临床显著预测因素。在纳入研究的70例患者中，最终对其中50例进行了分析。撤离简单和复杂的患者分别为30例和20例。DE在预测简单撤离与复杂撤离方面具有显著意义（p<0.001）。受试者工作特征曲线显示截断值为10.5 mm，曲线下面积为0.986（95%置信区间：0.903 - 1.000），p<0.0001。该测试显示敏感性为96.77%，特异性为100%。与DE>10.5 mm的患者相比，插管前DE<10.5 mm的患者需要更多天数进行撤离[中位数（四分位间距）为8（7 - 40）]和入住重症监护病房[16.50（10 - 50）]，而DE>10.5 mm的患者分别为[4（2 - 40）]和8.50（5 - 52），差异具有显著性，p<0.001。总之，插管前超声测量的DE小于10.5 mm可有效预测复杂撤离，可能有助于预后评估。
