Weaning failure and respiratory muscle function: What has been done and what can be improved?

Magalhães, Paulo; Camillo, Carlos Augusto; Langer, Daniël; Andrade, Lívia Barboza de; Duarte, Mariano; Gosselink, Rik

doi:10.1016/j.rmed.2017.11.023

Cited by 33 publications

(24 citation statements)

References 78 publications

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“…Weaning predictors -such as rapid shallow breathing index (RSBI), airway occlusion pressure 0.1 s (P0.1), maximum inspiratory pressure (PImax), and the weaning index -have been used to improve the rate of successful weaning in adult studies. [7][8][9] Unfortunately, in terms of weaning success in children, there is an insufficient amount of data to suggest the usefulness of predictors being superior to clinical judgment. [10] As a new technology in recent years, diaphragm ultrasound allows for the direct visualisation of the diaphragmatic function of patients, [11][12][13] which has the advantages of being noninvasive, rapid, and easy to perform at the bedside.…”

Section: Introductionmentioning

confidence: 99%

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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Section: Introductionmentioning

confidence: 99%

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

Yang

Zhang

Sheng

et al. 2019

Preprint

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“…Although feasibility of diaphragm SWE in the left zone of apposition (and other approaches) remain to be investigated, it might be particularly useful for detecting diaphragm hemi-paralysis. Diaphragm SWE might also be particularly relevant within spontaneous breathing trials and/or pressure support ventilation in ventilated patients during the weaning phase (22,25).…”

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confidence: 99%

Diaphragm shear modulus reflects transdiaphragmatic pressure during isovolumetric inspiratory efforts and ventilation against inspiratory loading

Bachasson

Dres

Niérat

et al. 2019

Journal of Applied Physiology

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The reference method for the assessment of diaphragm function relies on the measurement of transdiaphragmatic pressure (Pdi). Local muscle stiffness measured using ultrafast shear wave elastography (SWE) provides reliable estimates of muscle force in locomotor muscles. This study aimed at investigating whether SWE could be used as a surrogate of Pdi to evaluate diaphragm function. Fifteen healthy volunteers underwent a randomized stepwise inspiratory loading protocol of 0–60% of maximal isovolumetric inspiratory pressure during closed-airways maneuvers and 0–50% during ventilation against an external inspiratory threshold load. During all tasks, Pdi was measured and SWE was used to assess shear modulus of the right hemidiaphragm (SMdi) at the zone of apposition. Pearson correlation coefficients ( r) and repeated-measures correlation coefficients ( R) were computed to determine within-individual and overall relationships between Pdi and SMdi, respectively. During closed-airways maneuvers, mean Pdi correlated to mean SMdi in all participants [ r ranged from 0.77 to 0.96, all P < 0.01; R = 0.82, 95% confidence intervals (0.76, 0.86), P < 0.01]. During ventilation against inspiratory threshold loading, Pdi swing correlated to maximal SMdi in all participants [ r ranged from 0.40 to 0.90, all P < 0.01; R = 0.70, 95% confidence intervals (0.66, 0.73), P < 0.001]. Changes in diaphragm stiffness as assessed by SWE reflect changes in transdiaphragmatic pressure. SWE provides a new opportunity for direct and noninvasive assessment of diaphragm function. NEW & NOTEWORTHY Accurate and specific estimation of diaphragm effort is critical for evaluating and monitoring diaphragm dysfunction. The measurement of transdiaphragmatic pressure requires the use of invasive gastric and esophageal probes. In the present work, we demonstrate that changes in diaphragm stiffness assessed with ultrasound shear wave elastography reflect changes in transdiaphragmatic pressure, therefore offering a new noninvasive method for gauging diaphragm effort.

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“…A Pimáx é tida como a máxima pressão negativa, gerada na via aérea, a partir do volume residual durante uma manobra de inspiração forçada. Sendo assim, reflete a força dos músculos inspiratórios e é um importante determinante de fraqueza muscular inspiratória, que pode implicar na impossibilidade de manutenção da respiração espontânea (Magalhães 2018;NEMER, 2007). Valores de Pimáx menores que -20 a -30cmH 2 O são considerados como preditores de uma extubação malsucedida.…”

Section: Variáveisunclassified

Taxa de Sucesso do Desmame Ventilatório de Pacientes Mecanicamente Ventilados: Estudo de Demanda para Indicador de Qualidade de uma UTI de Hospital Público de Campo Grande, MS

Bezerra

Pereirab

2019

Ens Cien C Biol Agra Saúde

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O desmame ventilatório é o processo de descontinuação da ventilação mecânica invasiva - VMI e retirada da prótese endotraqueal, quando opaciente está apto a retornar para a ventilação espontânea. A mensuração da taxa do sucesso do desmame ventilatório oferece dados quantificáveis referentes ao desfecho da interrupção da VMI, podendo este ser utilizado para a criação de um indicador de qualidade. Indicadores de qualidade são medidas utilizadas para descrever uma situação existente e são ferramentas importantes para avaliar o desempenho e realizar planejamentos. Objetiva-se mensurar a taxa de sucesso e insucesso da extubação, identificando o processo do desmame ventilatório e coletando informações para a elaboração de um indicador de qualidade do serviço de fisioterapia. Tratou-se de um estudo clínico prospectivo observacional, com coleta de dados de pacientes internados na UTI, sob VMI aptos à realização do teste de respiração espontânea - TRE. Após a extubação, o participante foi incluído no grupo sucesso ou no grupo falha da extubação. Foram incluídos 50 participantes sob VMI aptos a realização do teste de respiração espontânea, seguido da extubação. Destes, 29(58%) eram do sexo masculino e 21(42%) do sexo feminino. A média de idade foi de 59,0±17,9 anos. A taxa de sucesso da extubação foi de 86%(43). Conclui-se que para a amostra estudada, considerando suas características, a taxa de sucesso da extubação se aproxima das descritas na literatura. Porém, esta taxa não se mostrou adequada para compor um indicador de qualidade do serviço de fisioterapia.Palavras-chave: Indicadores de Qualidade. Desmame do Respirador Mecânico. Extubação.Abstractventilatory weaning is the weaning process of mechanical ventilation and removal of the endotracheal prosthesis when the patient is ableto return to spontaneous ventilation. The measurement of the success rate of ventilatory weaning provides quantifiable data regarding theoutcome of the IMV interruption, which can be used to create a quality indicator. Quality indicators are measures used to describe an existingsituation and are important tools for evaluating performance and planning. to measure the success rate and failure of extubation, identifying the ventilatory weaning process and collecting information for the elaboration of a quality indicator of the physiotherapy service. it wasa prospective observational clinical study with data collection of patients in an intensive care unit in IMV able to undergo to spontaneousbreathing trial (SBT). After extubation, the participant was included in the success group or in the extubation failure group. Fifty participantsin IMV were eligible to perform the spontaneous breathing test and extubation. Of these 29 (58%) were male and 21 (42%) were female. The mean age was 59.0 ± 17.9 years. The success rate of extubation was 86% (43). it is concluded that for the studied sample, considering its characteristics, the success rate of extubation is close to those described in the literature. However, this rate was not adequate to compose a quality indicator of the physiotherapy service.Keywords: Quality Indicators. Mechanical Ventilation Weaning. Extubation.

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Weaning failure and respiratory muscle function: What has been done and what can be improved?

Cited by 33 publications

References 78 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

Diaphragm shear modulus reflects transdiaphragmatic pressure during isovolumetric inspiratory efforts and ventilation against inspiratory loading

Taxa de Sucesso do Desmame Ventilatório de Pacientes Mecanicamente Ventilados: Estudo de Demanda para Indicador de Qualidade de uma UTI de Hospital Público de Campo Grande, MS

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