Huang Yuan-Qin, Yu Pei, Xiang Dou-Dou, Gan Quan
Department of Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Wuhan, China.
Department of Intensive Care Unit, Wuhan Asia Heart Hospital, Wuhan, China.
Acute Crit Care. 2025 Aug;40(3):435-443. doi: 10.4266/acc.004320. Epub 2025 Aug 21.
To explore the value of the diaphragm thickness fraction (TF) and diaphragm mobility (DM) measured by ultrasound for predicting ventilator withdrawal success in patients with acute respiratory distress syndrome (ARDS) after cardiac surgery.
This study included 246 patients undergoing the spontaneous breathing trial. Diaphragmatic function was evaluated by ultrasound, including the diaphragm thickness at the end of calm breathing (thickness of the diaphragm at functional residual capacity [TdiFRC]) and the maximum diaphragm thickness at the end of inspiration (thickness of the diaphragm at full vital capacity [TdiFVC]); TF=(TdiFVC-TdiFRC)/TdiFRC×100%. DM, the oxygenation index (the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen), and the rapid shallow breathing index (RSBI) were measured.
Successful liberation from mechanical ventilation was observed in 209 patients. There were no significant differences in the TdiFRC (0.3±0.1 cm vs. 0.3±0.1 cm) or TdiFVC (0.3±0.1 cm vs. 0.2±0.1 cm) between the ventilator withdrawal success group and the ventilator withdrawal failure group (P>0.05). The TF was greater in the ventilator withdrawal success group than in the ventilator withdrawal failure group (40.8%±15.8% vs. 37.7%±9.2%, P<0.01). DM in the ventilator withdrawal success group was greater than that in the ventilator withdrawal failure group (1.5±0.5 cm vs. 1.2±0.4 cm, P=0.040). The RSBI was lower in the ventilator withdrawal success group than in the ventilator withdrawal failure group (74.3±25.6 breaths·min-1·L -1 vs. 89.9±34.5 breaths·min-1·L -1, P<0.01).
Diaphragmatic ultrasound can be used to predict the success of ventilator withdrawal in patients with ARDS.
探讨超声测量膈肌厚度分数（TF）和膈肌移动度（DM）对预测心脏手术后急性呼吸窘迫综合征（ARDS）患者撤机成功的价值。
本研究纳入246例接受自主呼吸试验的患者。通过超声评估膈肌功能，包括平静呼吸末膈肌厚度（功能残气量时膈肌厚度[TdiFRC]）和吸气末最大膈肌厚度（肺活量时膈肌厚度[TdiFVC]）；TF =（TdiFVC - TdiFRC）/TdiFRC×100%。测量DM、氧合指数（动脉血氧分压与吸入氧分数之比）和快速浅呼吸指数（RSBI）。
209例患者成功撤机。撤机成功组与撤机失败组的TdiFRC（0.3±0.1 cm对0.3±0.1 cm）或TdiFVC（0.3±0.1 cm对0.2±0.1 cm）无显著差异（P>0.05）。撤机成功组的TF高于撤机失败组（40.8%±15.8%对37.7%±9.2%，P<0.01）。撤机成功组的DM大于撤机失败组（1.5±0.5 cm对1.2±0.4 cm，P = 0.040）。撤机成功组的RSBI低于撤机失败组（74.3±25.6次·分钟-1·升-1对89.9±34.5次·分钟-1·升-1，P<0.01）。
膈肌超声可用于预测ARDS患者撤机成功。
