Usefulness of diaphragmatic ultrasound in predicting extubation success

Varón-Vega, Fabio Andrés; Hernandez, Antonio; López, María Jesús Martín; Cáceres, Eder; Giraldo-Cadavid, Luis Fernando; Uribe-Hernández, Ana María; Crevoisier, Stephanie

doi:10.1016/j.medine.2020.04.001

Cited by 15 publications

(38 citation statements)

References 37 publications

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“…This goes in line with Kaur et al study, which included 216 mechanically ventilated patients planned for extubation to compare the integrated pulmonary index's prognostic ability in determining extubation failures and revealed that higher BMI was significantly related to extubation failures 24 . This finding was in contrast to Huang et al's study, which was conducted on 40 patients scheduled for extubation to evaluate the utility of M mode ultrasound for ventilator weaning in older patients and found no statistically significant differences between extubation failure and extubation success regarding BMI 15 .…”

Section: Discussioncontrasting

confidence: 99%

“…The mean of Diaphragmatic displacement (DM) among the diaphragmatic dysfunction patients was 10.67 and standard deviation is 5.9 in comparison to non-diaphragmatic dysfunction patients (11.99+1.75) & effect size was 0.251. 15 Precision of 2% -95% confidence level-study power of 80% Sample size should be at least 60, we already conducted the current study on 62 mechanically ventilated patients.…”

Section: Sample Sizementioning

confidence: 98%

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Evaluation of role of ultrasound in assessment of successful weaning from mechanical ventilation in critically ill patients

2022

Al-Azhar International Medical Journal

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Background: Mechanical ventilation waning failure is a common problem, and bedside ultrasonography could be helpful in prediction of the weaning process and its results. Aim of The Work:To ssess by means of ultrasound how diaphragmatic parameters are important in predicting weaning outcome by assessing diaphragmatic thickness, diaphragmatic mobility and variation. Patients and Methods: This study included 62 mechanically ventilated patients who were subjected to transthoracic ultrasonography of the diaphragm throughout a spontaneous breathing experiment and had been divided into two groups: successful extubation and unsuccessful extubation.Results: With a p-value of <0.001, a high DE after extubation was linked to extubation success. Extubation failure was linked to lower DTF before and after extubation, with a p-value of <0.001. DE before extubation > 15 had 100% sensitivity, 85.06% specificity, 70.5 PPV and 100% NPV with p-value <0.001 for detection of extubation failure. DTF before extubation > 20.4 had 93.55% sensitivity, 93.55% specificity, 93.5% PPV, and 93.5% NPV with p-value <0.001 or detection of extubation failure. MV duration was negatively correlated with DE before extubation in the success group and positively correlated with DE after extubation in the success group. Conclusion: Diaphragm ultrasound evaluation of DTF and DE is a simple new weaning index which can be used as a bedside technique in clinical practice and has promising predictors of weaning success or failure before and after extubation.

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Section: Discussioncontrasting

confidence: 99%

Section: Sample Sizementioning

confidence: 98%

Evaluation of role of ultrasound in assessment of successful weaning from mechanical ventilation in critically ill patients

2022

Al-Azhar International Medical Journal

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“…One of the main causes of referral to the intensive care unit (ICU) is the need for invasive mechanical ventilation (IMV) [1,2]. Patients need IMV when they lose the ability to perform spontaneous ventilation due to respiratory failure or are unable to protect the airways by lowering the level of consciousness [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Among them, diaphragmatic ultrasonography (USG) has become increasingly used, proving to be very important in the intensive care environment and in the assessment of the critical patient. This method is accessible and can evaluate in real time the function and structure of the diaphragm, being able to detect changes that may difficult the weaning [1,3,4,11,12].…”

Section: Introductionmentioning

confidence: 99%

“…Parameters such as excursion and thickness are some of the findings that guide us to identify atrophy, paralysis and other diaphragmatic dysfunctions [1]. In this sense, Carrie et al [13] assessed the performance of diaphragmatic USG to predict failure in weaning in patients under IMV using the maximum diaphragmatic excursion measurement, confirmed the ventilator-induced diaphragmatic dysfunction (VIDD) and suggests that the diaphragm is very sensitive to the absence of activity.…”

Section: Introductionmentioning

confidence: 99%

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Ultrassonografia diafragmática como preditora de desmame ventilatório: uma revisão sistemática

Cordeiro¹,

Soares

Oliveira

et al. 2022

Rev Bras Fisiol Exerc

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Objetivo: Revisar as evidências sobre a ultrassonografia diafragmática como preditor de sucesso no desmame ventilatório, usando a metodologia PICO e palavras-chave: Ultrassom, Diagnóstico por imagem, Diafragma, Desmame, Unidade de Terapia Intensiva, Respiração Artificial, Ventilação Mecânica, Desmame do Ventilador. Métodos: Estudos de coorte publicados foram usados sem restrições de idioma e ano que abordaram o uso de ultrassom para prever o sucesso no desmame e extubação ventilatória. Foram excluídos estudos com pacientes menores de 18 anos, relatos de casos, revisões de literatura, resultados que não trouxessem valor de corte para espessura e excursão diafragmática e definição de falha no processo de desmame e extubação. Resultados: Foram encontrados 459 estudos; após exclusão por duplicação e leitura de títulos e resumo, apenas 11 foram selecionados pelos critérios de inclusão. As amostras variaram de 34 a 193 indivíduos. Conclusão: Podemos evidenciar que o uso da USG para avaliar a espessura e excursão do diafragma em pacientes submetidos a suporte ventilatório invasivo é eficaz em predizer o sucesso no processo de desmame e extubação. A ultrassonografia diafragmática tem grande aplicabilidade para avaliar a capacidade de predizer sucesso ou falha na remoção do suporte ventilatório invasivo.

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Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis

Truong

Abo

Whish-Wilson

et al. 2023

Critical Care Medicine

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in the Critical Care Setting: A Systematic Review and Meta-Analysis OBJECTIVE: Significant variations exist in the use of respiratory muscle ultrasound in intensive care with no society-level consensus on the optimal methodology. This systematic review aims to evaluate, synthesize, and compare the clinimetric properties of different image acquisition and analysis methodologies.DATA SOURCES: Systematic search of five databases up to November 24, 2021. STUDY SELECTION:Studies were included if they enrolled at least 50 adult ICU patients, reported respiratory muscle (diaphragm or intercostal) ultrasound measuring either echotexture, muscle thickness, thickening fraction, or excursion, and evaluated at least one clinimetric property. Two independent reviewers assessed titles, abstracts, and full text against eligibility.DATA EXTRACTION: Study demographics, ultrasound methodologies, and clinimetric data.DATA SYNTHESIS: Sixty studies, including 5,025 patients, were included with 39 studies contributing to meta-analyses. Most commonly measured was diaphragm thickness (DT) or diaphragm thickening fraction (DTF) using a linear transducer in B-mode, or diaphragm excursion (DE) using a curvilinear transducer in M-mode. There are significant variations in imaging methodology and acquisition across all studies. Inter-and intrarater measurement reliabilities were generally excellent, with the highest reliability reported for DT (ICC, 0.98; 95% CI, 0.94-0.99). Pooled data demonstrated acceptable to excellent accuracy for DT, DTF, and DE to predicting weaning outcome after 48 to 72 hours postextubation (DTF AUC, 0.79; 95% CI, 0.73-0.85). DT imaging was responsive to change over time. Only three eligible studies were available for intercostal muscles. Intercostal thickening fraction was shown to have excellent accuracy of predicting weaning outcome after 48-hour postextubation (AUC, 0.84; 95% CI, 0.78-0.91). CONCLUSIONS:Diaphragm muscle ultrasound is reliable, valid, and responsive in ICU patients, but significant variation exists in the imaging acquisition and analysis methodologies. Future work should focus on developing standardized protocols for ultrasound imaging and consider further research into the role of intercostal muscle imaging.

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Usefulness of diaphragmatic ultrasound in predicting extubation success

Cited by 15 publications

References 37 publications

Evaluation of role of ultrasound in assessment of successful weaning from mechanical ventilation in critically ill patients

Evaluation of role of ultrasound in assessment of successful weaning from mechanical ventilation in critically ill patients

Ultrassonografia diafragmática como preditora de desmame ventilatório: uma revisão sistemática

Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis

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