Diaphragm and Lung Ultrasound to Predict Weaning Outcome

Llamas-Álvarez, Ana M.; Tenza-Lozano, Eva M.; Latour-Pérez, Jaime

doi:10.1016/j.chest.2017.08.028

Cited by 186 publications

(137 citation statements)

References 46 publications

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“…Post-cardiac surgery patients with unilateral diaphragmatic paralysis could be extubated without delay, when the contralateral diaphragm excursion was > 25 mm at maximal inspiratory effort [53]. In a meta-analysis of 10 studies evaluating diaphragm excursion to predict weaning failure and combining different definitions of weaning failure, the authors reported a sensitivity of 75% (95% CI 65-85) and specificity of 75% (95% CI 60-85), with substantial heterogeneity [54]. As diaphragm excursion is strongly dependent of lung volume [37], the reported heterogeneity could be explained by patient position and the timing of measurements, e.g., before/during the SBT and with or without ventilator assistance.…”

Section: Diaphragm Excursionmentioning

confidence: 99%

“…When performed during an SBT, TFdi > 30-36% has shown to predict extubation success [52,54,58]. Ferrari et al evaluated in 46 patients ventilated through a tracheostomy tube, the role of TFdi(max) of the right hemidiaphragm during an SBT, as a predictor of weaning outcome [59] and reported that a TFdi(max) > 36% was associated with a successful SBT (sensitivity 0.82; specificity 0.88; AUROC 0.95).…”

Section: Diaphragm Thickening Fractionmentioning

confidence: 99%

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Respiratory muscle ultrasonography: methodology, basic and advanced principles and clinical applications in ICU and ED patients—a narrative review

et al. 2020

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Respiratory muscle ultrasound is used to evaluate the anatomy and function of the respiratory muscle pump. It is a safe, repeatable, accurate, and non-invasive bedside technique that can be successfully applied in different settings, including general intensive care and the emergency department. Mastery of this technique allows the intensivist to rapidly diagnose and assess respiratory muscle dysfunction in critically ill patients and in patients with unexplained dyspnea. Furthermore, it can be used to assess patient-ventilator interaction and weaning failure in critically ill patients. This paper provides an overview of the basic and advanced principles underlying respiratory muscle ultrasound with an emphasis on the diaphragm. We review different ultrasound techniques useful for monitoring of the respiratory muscle pump and possible therapeutic consequences. Ideally, respiratory muscle ultrasound is used in conjunction with other components of critical care ultrasound to obtain a comprehensive evaluation of the critically ill patient. We propose the ABCDE-ultrasound approach, a systematic ultrasound evaluation of the heart, lungs and respiratory muscle pump, in patients with weaning failure.

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Section: Diaphragm Excursionmentioning

confidence: 99%

Section: Diaphragm Thickening Fractionmentioning

confidence: 99%

Respiratory muscle ultrasonography: methodology, basic and advanced principles and clinical applications in ICU and ED patients—a narrative review

et al. 2020

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“…A number of studies have investigated these two parameters, either individually or in combination, with the aim of identifying cut-off values as predictors of successful weaning (see Table 2) [43,53,[61][62][63][64][65][66][67][68][69][70][71][72][73]. However, the results have been heterogeneous in terms of outcome results and cut-off values due to differences in study protocol design and outcome designation.…”

Section: Diaphragm Ultrasound (Dus)mentioning

confidence: 99%

“…end-inspiratory thickness The authors found that cut-off values of DE ≥ 10.5 mm, Te-insp ≥ 21 mm, and DTF > 34.2% during SBT with pressure support were associated with successful weaning; combining a DE ≥ 10.5 mm with a Te-insp. ≥ 21 mm decreased the sensitivity to 64.9%, but increased specificity up to 100% for successful weaning Zambon et al[72] The authors describe both DE and DTF to be useful weaning predictors, but only DTF is shown to be an accurate index of diaphragmatic contractility workload Llamas-Alvarez et al[73] This systematic review and metanalysis concludes that diaphragm ultrasound measures (DTF > DE) can help predict weaning outcome. It also suggests that the accuracy of DTF and DE may be overestimated in the current literature depending on the patient subpopulation studied Vivier et al[53] The authors conducted a multicenter prospective study involving 191 patients where DTF and DE data were collected during T-piece SBTs.…”

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confidence: 96%

Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 1

et al. 2020

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Although mechanical ventilation may be a patient's vital ally during acute illness, it can quickly transform into an enemy during chronic conditions. The weaning process is the fundamental phase that enables the resumption of physiological respiratory function; however, it is also associated with a number of life-threatening complications, and a large percentage of critically ill patients never achieve airway device removal or require the resumption of mechanical ventilation just a few days post-weaning. Indeed, the weaning process is, at present, more of an art than a science. As such, there is urgent need for novel contributions from the scientific literature to abate the growing rates of morbidity and mortality associated with weaning failure. The physician attempting to wean a patient must integrate clinical parameters and common-sense criteria. Numerous studies have striven to identify single predictive factors of weaning failure and sought to standardize the weaning process, but the results are characterized by remarkable heterogeneity. Despite the lack of benchmarks, it is clear that the analysis of respiratory function must include a detailed overview of the five situations described below rather than a single aspect. The purpose of this two-part review is to provide a comprehensive description of these situations to clarify the "arena" physicians are entering when weaning critically ill patients from mechanical ventilation. Publisher's NoteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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“…The monitoring of lung aeration during the weaning process embodies another essential aspect of LUS evaluation since it indirectly leads to successful extubation [9]. Clear evidence of the usefulness of the LUS score in the weaning process is provided in the metanalysis by Llamas-Álvarez et al in which ultrasound evaluation is concluded to provide valuable information in predicting weaning outcome [10]. Tenza-Lozano et al also came to this conclusion and went on to propose a new and more reproducible score that only considers the anterior, lateral, and posterior-basal thoracic areas [11].…”

Section: Lung Ultrasound Score (Lus)mentioning

confidence: 99%

Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 2

et al. 2020

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Assessing heart and diaphragm function constitutes only one of the steps to consider along the weaning path. In this second part of the review, we will deal with the more systematic evaluation of the pulmonary parenchyma-often implicated in the genesis of respiratory failure. We will also consider the other possible causes of weaning failure that lie beyond the cardio-pulmonary-diaphragmatic system. Finally, we will take a moment to consider the remaining unsolved problems arising from mechanical ventilation and describe the so-called protective approach to parenchyma and diaphragm ventilation.

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Diaphragm and Lung Ultrasound to Predict Weaning Outcome

Cited by 186 publications

References 46 publications

Respiratory muscle ultrasonography: methodology, basic and advanced principles and clinical applications in ICU and ED patients—a narrative review

Respiratory muscle ultrasonography: methodology, basic and advanced principles and clinical applications in ICU and ED patients—a narrative review

Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 1

Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 2

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