Diaphragmatic parameters by ultrasonography for predicting weaning outcomes

Theerawit, Pongdhep; Eksombatchai, Dararat; Sutherasan, Yuda; Suwatanapongched, Thitiporn; Kiatboonsri, Charn; Kiatboonsri, Sumalee

doi:10.1186/s12890-018-0739-9

Cited by 46 publications

(66 citation statements)

References 33 publications

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“…This paper is the first study to investigate the predictive value of diaphragm ultrasound for weaning outcomes in critically ill children. The findings of this study demonstrate that the DTF of patients in the group of weaning failure were significantly lower than those in the successful group, which is consistent with the results of previous studies [21, 25, 26], indicating that the patients with weaning failure generally had diaphragmatic dysfunction. At the same time, the study also demonstrates that the duration of MV in the failed group was significantly longer than that in the successful group, suggesting that the prolonged MV had promoted the occurrence of diaphragmatic dysfunction.…”

Section: Discussionsupporting

confidence: 92%

The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

et al. 2019

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IntroductionMultiple studies have shown that diaphragmatic ultrasound can better predict the outcome of weaning in adults. However, there are few studies focusing on children, leading to a lack of sufficient clinical evidence for the application of diaphragmatic ultrasound in children. The purpose of this study was to investigate the predictive value of diaphragm ultrasound for weaning outcomes in critically ill children.MethodsThe study included 50 cases whose mechanical ventilation (MV) time was > 48 h, and all eligibles were divided into either the weaning success group (n = 39) or the weaning failure group (n = 11). Diaphragm thickness, diaphragmatic excursion (DE), and diaphragmatic thickening fraction (DTF) were measured in the zone of apposition. The maximum inspiratory pressure (PImax) was also recorded.ResultsThe ventilatory treatment time (P = 0.002) and length of PICU stay (P = 0.013) in the weaning failure group was longer than the success group. Cut-off values of diaphragmatic measures associated with successful weaning were ≥ 21% for DTF with a sensitivity of 0.82 and a specificity of 0.81, whereas it was ≥0.86 cm H2O/kg for PImax with a sensitivity of 0.51 and a specificity of 0.82. The linear correlation analysis showed that DTF had a significant positive correlation with PImax in children (P = 0.003).ConclusionsDiaphragm ultrasound has potential value in predicting the weaning outcome of critically ill children. DTF and PImax presented better performance than other diaphragmatic parameters. However, DE has limited value in predicting weaning outcomes of children with MV.Trial registrationCurrent Controlled Trials ChiCTR1800020196, (Dec 2018).

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Section: Discussionsupporting

confidence: 92%

The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

et al. 2019

View full text Add to dashboard Cite

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“…This paper is the first study to investigate the predictive value of diaphragm ultrasound for weaning outcomes in critically ill children. The findings of this study demonstrate that the DTF of patients in the group of weaning failure were significantly lower than those in the successful group, which is consistent with the results of previous study, [21,25,26] indicating that the patients with weaning failure generally had diaphragmatic dysfunction (DD). At the same time, the study also demonstrates that the duration of MV in the failed group was significantly longer than that in the successful group, suggesting that the prolonged MV had promoted the occurrence of DD.…”

Section: Discussionsupporting

confidence: 92%

The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

Yang

Zhang

Sheng

et al. 2019

Preprint

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Background: Multiple studies have shown that diaphragmatic ultrasound can better predict the outcome of weaning in adults. However, there are few studies focusing on children, leading to a lack of sufficient clinical evidence for the application of diaphragmatic ultrasound in children. The purpose of this study is to investigate the predictive value of diaphragm ultrasound for weaning outcomes in critically ill children. Methods: The study included 50 cases whose mechanical ventilation (MV) time was >48 h, and all eligibles were divided into either the weaning success group (n = 39) or the weaning failure group (n = 11). Diaphragm thickness, diaphragmatic excursion (DE), and diaphragmatic thickening fraction (DTF) were measured in the zone of apposition. The maximum inspiratory pressure (PImax) was also recorded. Results: The ventilatory treatment time ( P = 0.002) and length of PICU stay ( P = 0.013) in the weaning failure group was longer than the success group. Cut-off values of diaphragmatic measures associated with successful weaning were ≥21% for DTF with a sensitivity of 0.82 and a specificity of 0.81, whereas it was ≥0.86 cmH 2 O/kg for PImax with a sensitivity of 0.51 and a specificity of 0.82. The linear correlation analysis showed that DTF had significant correlation with PImax in children ( P = 0.003). Conclusions: Diaphragm ultrasound has great value in predicting the weaning outcome of critically ill children. DTF and PImax presented better performance than other diaphragmatic parameters. However, DE has limited value in predicting weaning outcomes of children with MV.

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“…These results supported the conclusion that extubation failure was related to causes other than diaphragmatic factors. Additionally, the low significant negative correlation between the APACHE II score and DE and non-significant correlation between the APACHE II score and DTF parameters supported the conclusion that there were no large differences in the parameters affecting the diaphragm level between the two groups 18 . This finding could also be explained by the idea that DTF represents the number of fibers in the diaphragm, whereas DE represents the diaphragm function that can be affected by various measures included in the APACHE II score and explains why the score is correlated with the DE but not with the DTF.…”

Section: Discussionmentioning

confidence: 70%

Role of Bedside Ultrasonography in Assessment of Diaphragm Function as a Predictor of Success of Weaning in Mechanically Ventilated Patients

et al. 2020

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Background: Weaning failure is common in mechanically ventilated patients, and if ultrasound can predict weaning outcome remains controversial. The purpose of this study was to evaluate the diaphragmatic function (thickness and excursion) measured by ultrasound as a predictor of the extubation outcome. Methods: We included 62 mechanically ventilated patients from the chest intensive care unit in this study. Sixty-two patients who successfully passed the spontaneous breathing trial (SBT) were enrolled. The transthoracic ultrasound of the diaphragm was performed during an SBT to the assess diaphragmatic function (excursion and thickness), and they were classified into the successful extubation group and the failed extubation group. Results: There was a statistically significant increase in the successful extubation group in the diaphragmatic excursion and thickness fraction (p<0.001), a statistically significant negative correlation between the diaphragmatic function and the duration of the mechanical ventilation, and a statistically significant negative correlation between the diaphragmatic excursion and the Acute Physiology and Chronic Health Evaluation II. The diaphragmatic excursion cutoff value predictive of weaning was 1.25 cm, with a specificity of 82.1% and a sensitivity of 97.1% respectively, and the diaphragmatic thickness cutoff value predictive of weaning was 21.5%, with a specificity of 60.7% and a sensitivity of 91.2%, respectively. Conclusion: The diaphragmatic ultrasonography was found to be a promising tool for predicting the extubation outcome for mechanically ventilated patients.

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Diaphragmatic parameters by ultrasonography for predicting weaning outcomes

Cited by 46 publications

References 33 publications

The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

Role of Bedside Ultrasonography in Assessment of Diaphragm Function as a Predictor of Success of Weaning in Mechanically Ventilated Patients

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