Diaphragm and Lung Ultrasonography During Weaning From Mechanical Ventilation in Critically Ill Patients

Abstract

Aim: Optimum timing is crucial to avoid negative outcomes of weaning. We aimed to investigate predictive values of diaphragmatic thickening fraction (DTF), diaphragmatic excursion (DE), and anterolateral lung ultrasound (LUS) scores in extubation success and compare with rapid shallow breathing index (RSBI) in patients extubated under traditional parameters.Methods: Patients undergoing mechanical ventilation for >48 hours were included in the study. In patients planned for extubation, sonographic evaluations of the diaphragm and lung were performed at the T-tube stage. RSBI was achieved in the pressure support (PS) ventilation stage. Predictive values of DTF, DE, and anterolateral LUS scores were compared with RSBI in extubation success.Results: Sixty-two patients were enrolled in the study. The study population consisted mostly of trauma patients (77%). A cut-off value of 64 was obtained for RSBI. The positive predictive value (PPV) was found at 97% in extubation success. Cut-off values of 27.5 for DTF, 1.3 cm for the DE, and 6.5 for LUS scores were obtained at the T-tube stage, respectively. PPVs of all sonographic parameters were found over 90%. At the first stage, weaning and extubation failures were determined as 35 and 9.6%, respectively. RSBI was found as a powerful parameter in determining extubation success (r=0.774, p≤0.001) and moderately correlated with sonographic parameters. Conclusion:Investigating the lung and diaphragm via ultrasound provides real-time information to increase extubation success. Cut-off values of 64 for RSBI, 27.5 for DTF, 1.3 cm for the DE, and 6.5 for LUS scores were obtained, respectively, and PPVs of all sonographic parameters were found over 90%. We consider that sonographic evaluations accompanied by an RSBI will increase extubation success in the weaning process.

Diaphragmatic ultrasonography-based rapid shallow breathing index for predicting weaning outcome during a pressure support ventilation spontaneous breathing trial

“…The measures of diaphragmatic function comprise DE and DTF, and DE is mainly related to the inspiratory volume during the inspiratory phase, regardless of whether it depends on muscle workload or ventilator support [ 24 , 25 ]. DTF, also known as the “ejection fraction” of the diaphragm, reflects the active contraction ability of the diaphragm in the face of mechanical load [ 22 , 26 , 27 ]. In the present study, both DE and DTF exhibited a higher predictive value than the RSBI, which is in line with previous studies [ 22 , 28 ].…”

A Prospective Comparative study between the Tobin Index and Integrative Weaning Index to predict the outcome of trials of weaning from mechanical ventilation

“…A study conducted by Gok et al [17] concluded that sonographic evaluations accompanied by an RSBI will increase extubation success in the weaning process. Weaning failure may be due to underlying lung pathologies such as pulmonary fibrosis, pulmonary hemorrhage, and diffuse pulmonary infiltrate and also weaning-induced pulmonary edema as a result of heart-lung interactions which may be diagnosed by echocardiographic assessment.…”

Diyafram ultrasonografisinin weaning başarısını tahmin etmedeki gücü

“…Among the sonographic values obtained in T-tube stages, it has a PPV of over 90% in determining extubation success, which is 27.5% for DTF and 64 breaths/minute/liter for RSBI. Using sonographic examinations accompanied by RSBI in Weaning increases success 26 . We found the DTF cut-off value to be 26%.…”