Combined Thoracic Ultrasound Assessment during a Successful Weaning Trial Predicts Postextubation Distress

Abstract

Background Recent studies suggest that isolated sonographic assessment of the respiratory, cardiac, or neuromuscular functions in mechanically ventilated patients may assist in identifying patients at risk of postextubation distress. The aim of the present study was to prospectively investigate the value of an integrated thoracic ultrasound evaluation, encompassing bedside respiratory, cardiac, and diaphragm sonographic data in predicting postextubation distress. Methods Longitudinal ultrasound data from 136 patients who were extubated after passing a trial of pressure support ventilation were measured immediately after the start and at the end of this trial. In case of postextubation distress (31 of 136 patients), an additional combined ultrasound assessment was performed while the patient was still in acute respiratory failure. We applied machine-learning methods to improve the accuracy of the related predictive assessments. Results Overall, integrated thoracic ultrasound models accurately predict postextubation distress when applied to thoracic ultrasound data immediately recorded before the start and at the end of the trial of pressure support ventilation (learning sample area under the curve: start, 0.921; end, 0.951; test sample area under the curve: start, 0.972; end, 0.920). Among integrated thoracic ultrasound data, the recognition of lung interstitial edema and the increased telediastolic left ventricular pressure were the most relevant predictive factors. In addition, the use of thoracic ultrasound appeared to be highly accurate in identifying the causes of postextubation distress. Conclusions The decision to attempt extubation could be significantly assisted by an integrative, dynamic, and fully bedside ultrasonographic assessment of cardiac, lung, and diaphragm functions.

ARDS: challenges in patient care and frontiers in research

“…Importantly, very similar phenotypes were found independently in a group of ARDS patients that was separated in time and place, and analysed using an alternative approach [67]. Progress in the identification of specific phenotypes is not only seen in ARDS, but also in other problems frequently encountered in the intensive care unit, such as sepsis and failure to wean [68][69][70].…”

The sound of air: point-of-care lung ultrasound in perioperative medicine

“…14,[39][40][41][42][43] Moderate loss of aeration is associated with the presence of C three well-defined spaced B lines/intercostal space (B1 pattern), while severe loss of lung aeration displays multiple coalescent B lines/ intercostal space (B2 pattern). 17,44,45 Although very sensitive for increased lung density, B lines lack specificity and have a broad differential diagnosis. 19 The clinical context and specific sonographic findings (e.g., B line distribution, B line density, gravitydependent vs -independent pattern, associated changes in lung sliding and pulse, associated pleural line and subpleural abnormalities, presence of fluid or air bronchograms) can be sought to narrow the differential diagnosis and increase specificity.…”

“…49 Further, several observational studies and a recent meta-analysis suggest higher accuracy of LUS for the diagnosis of heart failure than routine clinical workup, including chest radiography and natriuretic peptides. 6,8,9,50,51 Repeated LUS examinations allow monitoring of changes in lung aeration and/or extravascular lung water as a result of interventions such as dialysis, 14,52 heart failure treatment, 32,53 changes in positive pressure ventilation, 17,44,45 and whole lung lavage. 33 B lines may also have a prognostic role in heart failure and end-stage renal disease.…”

Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 2

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