Using automatic speckle tracking imaging to measure diaphragm excursion and predict the outcome of mechanical ventilation weaning

Huang, Daozheng; Song, Feier; Luo, Bangjun; Wang, Shouhong; Qin, Tiehe; Lin, Zhuandi; Hou, Tieying; Ma, Huan

doi:10.1186/s13054-022-04288-3

Cited by 9 publications

(4 citation statements)

References 25 publications

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“…Of note, two studies found no association between a low diaphragm TF and extubation failure during tidal breathing but not during SBT [ 5 , 70 ]. The same was reported for DE in another study [ 71 ]. This highlights the importance of evaluating the diaphragm during a challenge test.…”

Section: Impact On Outcomesupporting

confidence: 85%

Critical illness-associated limb and diaphragmatic weakness

Le Stang,

Latronico,

Dres

et al. 2024

Current Opinion in Critical Care

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Purpose of review In the current review, we aim to highlight the evolving evidence on the diagnosis, prevention and treatment of critical illness weakness (CIW) and critical illness associated diaphragmatic weakness (CIDW). Recent findings In the ICU, several risk factors can lead to CIW and CIDW. Recent evidence suggests that they have different pathophysiological mechanisms and impact on outcomes, although they share common risk factors and may overlap in several patients. Their diagnosis is challenging, because CIW diagnosis is primarily clinical and, therefore, difficult to obtain in the ICU population, and CIDW diagnosis is complex and not easily performed at the bedside. All of these issues lead to underdiagnosis of CIW and CIDW, which significantly increases the risk of complications and the impact on both short and long term outcomes. Moreover, recent studies have explored promising diagnostic techniques that are may be easily implemented in daily clinical practice. In addition, this review summarizes the latest research aimed at improving how to prevent and treat CIW and CIDW. Summary This review aims to clarify some uncertain aspects and provide helpful information on developing monitoring techniques and therapeutic interventions for managing CIW and CIDW.

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Section: Impact On Outcomesupporting

confidence: 85%

Critical illness-associated limb and diaphragmatic weakness

Le Stang,

Latronico,

Dres

et al. 2024

Current Opinion in Critical Care

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“…Hence, a one-dimensional measure is unsuitable to determine absolute values or a safe cutoff for TV. Advanced techniques such as speckle tracking may have superior performance by quantifying diaphragm motion in multiple dimensions [ 15 , 16 ]. Prior studies were often hampered by the application of inspiratory pressure support during ultrasound measurements.…”

Section: Discussionmentioning

confidence: 99%

Diaphragm excursions as proxy for tidal volume during spontaneous breathing in invasively ventilated ICU patients

Janssen,

Jonkman,

Wennen

et al. 2023

ICMx

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There is a need to monitor tidal volume in critically ill patients with acute respiratory failure, given its relation with adverse clinical outcome. However, quantification of tidal volume in non-intubated patients is challenging. In this proof-of-concept study, we evaluated whether ultrasound measurements of diaphragm excursion could be a valid surrogate for tidal volume in patients with respiratory failure. Diaphragm excursions and tidal volumes were simultaneously measured in invasively ventilated patients (N = 21) and healthy volunteers (N = 20). Linear mixed models were used to estimate the ratio between tidal volume and diaphragm excursion. The tidal volume–diaphragm excursion ratio was 201 mL/cm in ICU patients [95% confidence interval (CI) 161–240 mL/cm], and 361 (294–428) mL/cm in healthy volunteers. An excellent association was shown within participants (R2 = 0.96 in ICU patients, R2 = 0.90 in healthy volunteers). However, the differences between observed tidal volume and tidal volume as predicted by the linear mixed models were considerable: the 95% limits of agreement in Bland–Altman plots were ± 91 mL in ICU patients and ± 396 mL in healthy volunteers. Likewise, the variability in tidal volume estimation between participants was large. This study shows that diaphragm excursions measured with ultrasound correlate with tidal volume, yet quantification of absolute tidal volume from diaphragm excursion is unreliable.

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“…However, since we focused on the ultrasound test that was supported by the most evidence of validation at the time of data collection [16, 23-25, 30, 31], a cutaneous marker was not applied to minimize the variability of the ultrasound measurements, as described by Goligher et al [23]. In addition, advanced tools that are used to evaluate diaphragmatic function, such as tissue Doppler and speckle tracking, were not utilized [36][37][38][39].…”

Section: Limitationsmentioning

confidence: 99%

Utilization of spontaneous breathing trial, objective cough test, and diaphragmatic ultrasound results to predict extubation success: COBRE-US trial

Varón-Vega,

Giraldo-Cadavid,

Uribe

et al. 2023

Crit Care

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Background The results of clinical and weaning readiness tests and the spontaneous breathing trial (SBT) are used to predict the success of the weaning process and extubation. Methods We evaluated the capacity of the cuff leak test, rate of rapid and shallow breathing, cough intensity, and diaphragmatic contraction velocity (DCV) to predict the success of the SBT and extubation in a prospective, multicenter observational study with consecutive adult patients admitted to four intensive care units. We used receiver operating characteristic (ROC) curves to assess the tests’ predictive capacity and built predictive models using logistic regression. Results We recruited 367 subjects who were receiving invasive mechanical ventilation and on whom 456 SBTs were performed, with a success rate of 76.5%. To predict the success of the SBT, we derived the following equation: (0.56 × Cough) − (0.13 × DCV) + 0.25. When the cutoff point was ≥ 0.83, the sensitivity was 91.5%, the specificity was 22.1%, and the overall accuracy was 76.2%. The area under the ROC curve (AUC-ROC) was 0.63. To predict extubation success, we derived the following equation: (5.7 × SBT) + (0.75 × Cough) − (0.25 × DCV) − 4.5. When the cutoff point was ≥ 1.25, the sensitivity was 96.8%, the specificity was 78.4%, and the overall accuracy was 91.5%. The AUC-ROC of this model was 0.91. Conclusion Objective measurement of cough and diaphragmatic contraction velocity could be used to predict SBT success. The equation for predicting successful extubation, which includes SBT, cough, and diaphragmatic contraction velocity values, showed excellent discriminative capacity.

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Using automatic speckle tracking imaging to measure diaphragm excursion and predict the outcome of mechanical ventilation weaning

Cited by 9 publications

References 25 publications

Critical illness-associated limb and diaphragmatic weakness

Critical illness-associated limb and diaphragmatic weakness

Diaphragm excursions as proxy for tidal volume during spontaneous breathing in invasively ventilated ICU patients

Utilization of spontaneous breathing trial, objective cough test, and diaphragmatic ultrasound results to predict extubation success: COBRE-US trial

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