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

Tuberculosis and Respiratory Diseases 2020년 83권 4호 p.295 ~ 302
Elshazly Mostafa Ibrahim, Kamel Khaled Mahmoud, Elkorashy Reem Ibrahim, Ismail Mohamed Said, Ismail Jumana Hesham, Assal Hebatallah Hany,
소속 상세정보
 ( Elshazly Mostafa Ibrahim ) - Cairo University Faculty of Medicine Department of Chest Medicine
 ( Kamel Khaled Mahmoud ) - Cairo University Faculty of Medicine Department of Chest Medicine
 ( Elkorashy Reem Ibrahim ) - Cairo University Faculty of Medicine Department of Chest Medicine
 ( Ismail Mohamed Said ) - Cairo University Faculty of Medicine Department of Chest Medicine
 ( Ismail Jumana Hesham ) - Cairo University Faculty of Medicine Department of Chest Medicine
 ( Assal Hebatallah Hany ) - Cairo University Faculty of Medicine Department of Chest Medicine

Abstract


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 cut-off 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 cut-off 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.

키워드

Weaning; Transthoracic Ultrasound; Diaphragmatic Excursion; Diaphragmatic Thickness Fraction; Successful Extubation; Failed Extubation

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