Change in Diaphragmatic Thickness During the Respiratory Cycle Predicts Extubation Success at Various Levels of Pressure Support Ventilation

Blumhof, Scott; Wheeler, David; Thomas, Kendol; McCool, F. Dennis; Mora, Jorge

doi:10.1007/s00408-016-9911-2

Cited by 76 publications

(48 citation statements)

References 22 publications

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“…Our study found that a right DTF of more than or equal to 26% had the most accuracy for predicting weaning successfulness. This result is consistent with the studies from Ferrari et al [ 22 ], DiNino et al [ 27 ], Dube et al [ 18 ], and Blumhof et al [ 28 ] which demonstrated that right DTFs of more than 36, 30, 29, and 20%, respectively, were associated with weaning success and better ICU outcomes. Most of these studies confirmed DTF alone as a better weaning predictor compared to RSBI, in terms of specificity without sensitivity extenuation.…”

Section: Discussionsupporting

confidence: 93%

Use of diaphragm thickening fraction combined with rapid shallow breathing index for predicting success of weaning from mechanical ventilator in medical patients

Pirompanich

Romsaiyut

2018

j intensive care

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BackgroundWeaning failure is a crucial hindrance in critically ill patients. Rapid shallow breathing index (RSBI), a well-known weaning index, has some limitations in predicting weaning outcomes. A new weaning index using point-of-care ultrasound with diaphragmic thickening fraction (DTF) has potential benefits for improving weaning success. The aim of this study was to evaluate the efficacy of a combination of DTF and RSBI for predicting successful weaning compared to RSBI alone.MethodsThis prospective study enrolled patients from the medical intensive care unit or ward who were using mechanical ventilation and readied for weaning. Patients underwent a spontaneous breathing trial (SBT) for 1 h, and then, both hemi-diaphragms were visualized in the zone of apposition using a 10-MHz linear probe. Diaphragm thickness was recorded at the end of inspiration and expiration which supposed the lung volume equal to total lung capacity (TLC) and residual volume (RV), respectively, and the DTF was calculated as a percentage from this formula: thickness at TLC minus thickness at RV divided by thickness at RV. In addition, RSBI was calculated at 1 min after SBT. Weaning failure was defined as the inability to maintain spontaneous breathing within 48 h.ResultsOf the 34 patients enrolled, the mean (± SD) age was 66.5 (± 13.5) years. There were 25 patients with weaning success, 9 patients in the weaning failure group. The receiver operating characteristic curves of right and left DTF and the RSBI for the prediction of successful weaning were 0.951, 0.700, and 0.709, respectively. The most accurate cutoff value for prediction of successful weaning was right DTF ≥ 26% (sensitivity of 96%, specificity of 68%, positive predictive value of 89%, negative predictive value of 86%). The combination of right DTF ≥ 26% and RSBI ≤ 105 increased specificity to 78% but slightly decreased sensitivity to 92%. Intra-observer correlation increased sharply to almost 0.9 in the first ten patients and slightly increased after that.ConclusionsPoint-of-care ultrasound to assess diaphragm function has an excellent learning curve and helps physicians determine weaning readiness in critically ill patients. The combination of right DTF and RSBI greatly improved the accuracy for prediction of successful weaning compared to RSBI alone.Trial registrationThai Clinical Trials Registry, TCTR20171025001. Retrospectively registered on October 23, 2017.

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Section: Discussionsupporting

confidence: 93%

Use of diaphragm thickening fraction combined with rapid shallow breathing index for predicting success of weaning from mechanical ventilator in medical patients

Pirompanich

Romsaiyut

2018

j intensive care

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“…Because of its negative impact on weaning, it may be worthwhile to use diaphragm function as a predictor of weaning failure. Patients with weaning failure consistently have a lower TFdi compared to patients with successful weaning ( [5,6,[32][33][34][35]; Table 2). From these studies, the optimal Tfdi cut-off to predict successful weaning ranges from 20 to 36% depending on the ventilator support provided during the measurement; the higher the support, the lower the Tfdi.…”

Section: Presence and Impact Of Diaphragm Dysfunction At The Time Of mentioning

confidence: 99%

Diaphragm Dysfunction during Weaning from Mechanical Ventilation: An Underestimated Phenomenon with Clinical Implications

Dres

Demoule

2018

Annual Update in Intensive Care and Emergency Medicine 2018

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“…In contrast, TFdi has been shown to be correlated to the pressure-generating capacity of the diaphragm [58,128], to the work of breathing and respiratory effort [118,129] and can be used as a valid tool to identify diaphragm dysfunction [130,131], monitor its temporal changes [29,125] and may predict weaning outcomes in patients under invasive or non-invasive ventilation [53,58,59,132,133]. The reported lower limit of the normal value for TFdi is 20% in healthy subjects and patients with COPD [120,122].…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Dubé

Dres

2016

JCM

157

109

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The diaphragm is the main inspiratory muscle, and its dysfunction can lead to significant adverse clinical consequences. The aim of this review is to provide clinicians with an overview of the main causes of uni- and bi-lateral diaphragm dysfunction, explore the clinical and physiological consequences of the disease on lung function, exercise physiology and sleep and review the available diagnostic tools used in the evaluation of diaphragm function. A particular emphasis is placed on the clinical significance of diaphragm weakness in the intensive care unit setting and the use of ultrasound to evaluate diaphragmatic action.

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Change in Diaphragmatic Thickness During the Respiratory Cycle Predicts Extubation Success at Various Levels of Pressure Support Ventilation

Abstract: Diaphragm US is a valid predictor of extubation success at some but not all PS settings. Using a ∆tdi% of 20 % on PS levels up to 10/5 cm of H2O may reduce both unnecessarily prolonged intubations and prevent emergent reintubations.

Cited by 76 publications

References 22 publications

Use of diaphragm thickening fraction combined with rapid shallow breathing index for predicting success of weaning from mechanical ventilator in medical patients

Use of diaphragm thickening fraction combined with rapid shallow breathing index for predicting success of weaning from mechanical ventilator in medical patients

Diaphragm Dysfunction during Weaning from Mechanical Ventilation: An Underestimated Phenomenon with Clinical Implications

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

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