Diaphragm thickening fraction to predict weaning-a prospective exploratory study

被引:35
|
作者
Samanta, Sujay [1 ]
Singh, Ratender Kumar [1 ]
Baronia, Arvind K. [1 ]
Poddar, Banani [1 ]
Azim, Afzal [1 ]
Gurjar, Mohan [1 ]
机构
[1] SGPGIMS, Dept Crit Care Med, Raebareli Rd, Lucknow 226014, Uttar Pradesh, India
来源
JOURNAL OF INTENSIVE CARE | 2017年 / 5卷
关键词
Weaning; Diaphragm ultrasound; Diaphragm thickening fraction; INTENSIVE-CARE-UNIT; MECHANICAL VENTILATION; EXTUBATION; DYSFUNCTION; ULTRASOUND; ULTRASONOGRAPHY; WEAKNESS; HUMANS;
D O I
10.1186/s40560-017-0258-4
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Diaphragm ultrasound (DUS) is a well-established point of care modality for assessment of dimensional and functional aspects of the diaphragm. Amongst various measures, diaphragmatic thickening fraction (DTf) is more comprehensive. However, there is still uncertainty about its capability to predict weaning from mechanical ventilation (MV). The present prospective observational exploratory study assessed the diaphragm at variable negative pressure triggers (NPTs) with US to predict weaning in ICU patients. Methods: Adult ICU patients about to receive their first T-piece were included in the study. Linear and curvilinear US probes were used to measure right side diaphragm characteristics first at pressure support ventilation (PSV) of 8 cmH2O with positive end expiratory pressure (PEEP) of 5 cmH2O against NPTs of 2, 4, and 6 cmH2O and then later during their first T-piece. The measured variables were then categorized into simple weaning (SW) and complicated weaning (CW) groups and their outcomes analyzed. Results: Sixty-four (M: F, 40: 24) medical (55/64, 86%) patients were included in the study. Sepsis of lung origin (65.5%) was the dominant reason for MV. There were 33 and 31 patients in the SW and CW groups, respectively. DTf predicts SW with ka cutoff >= 25.5, 26.5, 25.5, and 24.5 for 2, 4, and 6 NPTs and T-piece, respectively, with >= 0.90 ROC AUC. At NPT of 2, DTf had the highest sensitivity of 97% and specificity of 81% [ROC AUC (CI), 0.91 (0.84-0.99); p < 0.001]. Conclusions: DTf may successfully predict SW and also help identify patients ready to wean prior to a T-piece trial.
引用
收藏
页数:9
相关论文
共 50 条
  • [31] Mask Continuous Positive Airway Pressure Increases Diaphragm Thickening Fraction in Healthy Subjects
    Lindner, Simon
    Teichert, Jan
    Hoermann, Clara
    Michels, Julia D.
    Herth, Felix J. F.
    Duerschmied, Daniel
    Britsch, Simone
    RESPIRATION, 2024, 103 (02) : 100 - 104
  • [32] Diaphragmatic ultrasound as a predictive tool for weaning success in ICU: insights on excursion and thickening fraction
    Bekkaoui, Safaa
    Berrichi, Hajar
    Lamzouri, Oussama
    Bkiyar, Houssam
    Housni, Brahim
    INTENSIVE CARE MEDICINE, 2025, : 635 - 637
  • [33] Diaphragm ultrasound to predict weaning outcome: systematic review and meta-analysis
    Mahmoodpoor, Ata
    Fouladi, Shahnaz
    Ramouz, Ali
    Shadvar, Kamran
    Ostadi, Zohreh
    Soleimanpour, Hassan
    ANAESTHESIOLOGY INTENSIVE THERAPY, 2022, 54 (02) : 164 - 174
  • [34] Ultrasonographic evaluation of diaphragm thickness and excursion: correlation with weaning success in trauma patients: prospective cohort study
    Sabetian, Golnar
    Mackie, Mandana
    Asmarian, Naeimehossadat
    Banifatemi, Mahsa
    Schmidt, Gregory A.
    Masjedi, Mansoor
    Paydar, Shahram
    Zand, Farid
    JOURNAL OF ANESTHESIA, 2024, 38 (03) : 354 - 363
  • [35] Ultrasonographic evaluation of diaphragm thickness and excursion: correlation with weaning success in trauma patients: prospective cohort study
    Golnar Sabetian
    Mandana Mackie
    Naeimehossadat Asmarian
    Mahsa Banifatemi
    Gregory A. Schmidt
    Mansoor Masjedi
    Shahram Paydar
    Farid Zand
    Journal of Anesthesia, 2024, 38 : 354 - 363
  • [36] Sonographic assessment of diaphragmatic thickening and excursion as predictors of weaning success in the intensive care unit: A prospective observational study
    Kaur, Amandeep
    Sharma, Shruti
    Singh, Vikram P.
    Krishna, M. Ravi
    Gautam, Parshotam L.
    Singh, Gagandeep
    INDIAN JOURNAL OF ANAESTHESIA, 2022, 66 (11) : 776 - 782
  • [37] Use of diaphragm thickening fraction combined with rapid shallow breathing index for predicting success of weaning from mechanical ventilator in medical patients (vol 6, 6, 2018)
    Pirompanich, Pattarin
    Romsaiyut, Sasithon
    JOURNAL OF INTENSIVE CARE, 2018, 6
  • [38] Diaphragm Ultrasonography: Reference Values and Influencing Factors for Thickness, Thickening Fraction, and Excursion in the Seated Position
    Yamada, Toru
    Minami, Taro
    Yoshino, Syumpei
    Emoto, Ken
    Mabuchi, Suguru
    Hanazawa, Ryoichi
    Hirakawa, Akihiro
    Hashimoto, Masayoshi
    LUNG, 2024, 202 (01) : 83 - 90
  • [39] Diaphragm Ultrasonography: Reference Values and Influencing Factors for Thickness, Thickening Fraction, and Excursion in the Seated Position
    Toru Yamada
    Taro Minami
    Syumpei Yoshino
    Ken Emoto
    Suguru Mabuchi
    Ryoichi Hanazawa
    Akihiro Hirakawa
    Masayoshi Hashimoto
    Lung, 2024, 202 : 83 - 90
  • [40] Ultrasonography to Access Diaphragm Dysfunction and Predict the Success of Mechanical Ventilation Weaning in Critical Care
    Marques, Marta Rafael
    Pereira, Jose Manuel
    Paiva, Jose Artur
    de Casasola-Sanchez, Gonzalo Garcia
    Tung-Chen, Yale
    JOURNAL OF ULTRASOUND IN MEDICINE, 2024, 43 (02) : 223 - 236