Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index

Alam, Mohammad J; Roy, Simanta; Iktidar, Mohammad Azmain; Padma, Fahmida Khatun; Islam, A M Khairul; Chowdhury, Sreshtha; Nath, Ranjan Kumar; Rashid, Harunor

doi:10.4266/acc.2021.01354

Cited by 18 publications

(23 citation statements)

References 26 publications

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“…These findings are consistent with the findings of Kawar et al [23], where they found that a Δtdi% >30% had a sensitivity of 95% and a specificity of 68% for extubation success. Similar results were also demonstrated by Farghaly and Hasan [24] and Alam et al [25], where tdi-end expiration out-performed RSBI.…”

Section: Discussionsupporting

confidence: 87%

The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience

Lalwani

Singh

et al. 2022

Acute Crit Care

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Background: Acute respiratory failure (ARF) is commonly managed with invasive mechanical ventilation (IMV). The majority of the time that a patient spends on IMV is in the process of weaning. Prediction of the weaning outcome is of paramount importance, as untimely/delayed extubation is associated with a high risk of mortality. Diaphragmatic ultrasonography is a promising tool in the intensive care unit, and its utility in predicting the success of weaning remains understudied. Methods: In this prospective-observational study, we recruited 54 ARF patients on IMV, along with 50 healthy controls. During a spontaneous breathing trial, all subjects underwent diaphragmatic ultrasonography along with a rapid shallow breathing index (RSBI) assessment. Results: The mean age was 41.8±17.0 and 37.6±10.5 years among the cases and control group, respectively. Demographic variables were broadly similar in the two groups. The most common cause of ARF was obstructive airway disease. The average duration of IMV was 5.41±2.81 days. Out of 54 subjects, 45 were successfully weaned, while nine patients failed weaning. Age, body mass index, and severity of disease were similar in the successful and failed weaning patients. The sensitivity in predicting successful weaning of percent change in diaphragmatic thickness (Δtdi%) >29.71% was high (93.33%), while specificity was 66.67%. The sensitivity and specificity of mean diaphragmatic thickness (tdi) end-expiratory >0.178 cm was 60.00% and 77.78%, respectively. RSBI at 1 minute of <93.75 had an equally high sensitivity (93.33%) but a lower specificity (22.22%). Similar results were also found for RSBI measured at 5 minutes. Conclusions: During the weaning assessment, the purpose is to minimize both premature as well as delayed extubation. We found that diaphragmatic ultrasonography, in particular Δtdi%, is better than RSBI in predicting weaning outcomes.

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Section: Discussionsupporting

confidence: 87%

The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience

Lalwani

Singh

et al. 2022

Acute Crit Care

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“…The AUROC was 0.422, which was similar to other studies. [ 24 - 26 ] The lower the cut-off value, the higher the predictability in RSBI. It has the advantage of considering the balance between respiratory load and effort.…”

Section: Discussionmentioning

confidence: 99%

Role of diaphragm ultrasound in weaning mechanically ventilated patients: A prospective observational study

Saravanan¹,

Nivedita²,

Karthik³

et al. 2022

Indian J Anaesth

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Background and Aims: Weaning from mechanical ventilation based on clinical parameters and rapid shallow breathing index (RSBI) is associated with a higher weaning failure. Bedside ultrasound of the diaphragm is gaining popularity to assess the diaphragm function. The aim of our study was to determine the use of diaphragm ultrasound in weaning ventilated patients. Methods: This prospective study was done on 200 adult patients on mechanical ventilation for more than 24 h. After meeting the clinical weaning criteria, a spontaneous breathing trial (SBT) was performed. RSBI was recorded and a bedside ultrasound of the diaphragm was performed to measure diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF) before extubation. We assessed the predictability of weaning success of RSBI, DE and DTF by determining the area under the receiver operating characteristic (AUROC) curve and Youden’s index. The requirement of non-invasive ventilation or re-intubation within 48 h was considered a weaning failure. Results: Out of the 200 patients studied, 171 were successfully weaned. The AUROC values for RSBI, DTF, DE, RSBI-DTF and RSBI-DE for successful weaning prediction were 0.422, 0.654, 0.809, 0.656 and 0.807, respectively. The predictability using cut-off values were DE >1.21 cm (sensitivity 94%, specificity 71%, Youden’s index 0.65), DTF >37% (sensitivity 80%, specificity 52%, Youden’s index 0.31) and RSBI <82 (sensitivity 94%, specificity 31%, Youden’s index 0.25). Conclusion: Diaphragm ultrasound helps in predicting successful weaning in mechanically ventilated patients. Both DE and DTF showed a higher specificity than RSBI and a combination of RSBI-DE and RSBI-DTF was better than using RSBI alone.

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“…Alam et al [ 32 ] reported that successful extubation was significantly correlated with DE with an area under the curve (AUC) of 0.83 ( p < 0.001) and sensitivity 77.8% and specificity 84.6%. These results were consistent with several other studies that showed promising findings for using NIV-NAVA to facilitate extubation in preterm infants [ 10 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic assessment of diaphragmatic function in preterm infants on non-invasive neurally adjusted ventilatory assist (NIV-NAVA) compared to nasal intermittent positive-pressure ventilation (NIPPV): a prospective observational study

et al. 2022

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NIV-NAVA mode for respiratory support in preterm infants is not well-studied. This study aimed to describe the diaphragmatic function, diaphragmatic excursion (DE), and thickness fraction (DTF), in preterm infants < 30 weeks’ gestation supported by NIV-NAVA compared to NIPPV using bedside ultrasonography. In this consecutive prospective study, DE, diaphragmatic thickness at end of expiration (DT exp ), end of inspiration (DT ins ), and DTF were assessed using bedside ultrasound. Lung aeration evaluation using lung ultrasound score (LUS) was performed for the two groups. Diaphragmatic measurements and LUS were compared for the 2 groups (NIV-NAVA group versus NIPPV group). Statistical analyses were conducted using the SPSS software version 22. Out of 70 infants evaluated, 40 were enrolled. Twenty infants were on NIV-NAVA and 20 infants on NIPPV with a mean [SD] study age of 25.7 [0.9] weeks and 25.1 [1.4] weeks respectively ( p = 0.15). Baseline characteristics and respiratory parameters at the time of the scan showed no significant difference between groups. DE was significantly higher in NIV-NAVA with a mean SD of 4.7 (1.5) mm versus 3.5 (0.9) mm in NIPPV, p = 0.007. Additionally, the mean (SD) of DTF for the NIV-NAVA group was 81.6 (30) % vs 78.2 (27) % for the NIPPV group [ p = 0.71]. Both groups showed relatively high LUS but no significant difference between groups [12.8 (2.6) vs 12.6 (2.6), p = 0.8]. Conclusion : Preterm infants managed with NIV-NAVA showed significantly higher DE compared to those managed on NIPPV. This study raises the hypothesis that NIV-NAVA could potentially improve diaphragmatic function due to its synchronization with patients’ own breathing. Longitudinal studies to assess diaphragmatic function over time are needed. Trial registry : Clinicaltrials.gov (NCT05079412). Date of registration September 30, 2021. What is Known: • NIV-NAVA utilizes diaphragmatic electrical activity to provide synchronized breathing support. • Evidence for the effect of NIV-NAVA on diaphragmatic thickness fraction (DTF) and excursion (DE) is limited. What is New: • Ultrasonographic assessment of diaphragmatic function (DTF and DE) is feasible. • In preterm infants, DE was significantly higher in infants supported with NIV-NAVA compared to those supported with NIPPV.

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Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index

Cited by 18 publications

References 26 publications

The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience

The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience

Role of diaphragm ultrasound in weaning mechanically ventilated patients: A prospective observational study

Ultrasonographic assessment of diaphragmatic function in preterm infants on non-invasive neurally adjusted ventilatory assist (NIV-NAVA) compared to nasal intermittent positive-pressure ventilation (NIPPV): a prospective observational study

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