Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients

Background: Diaphragm dysfunction (DD) is frequently seen in critically ill patients, and ultrasound could be a useful tool to detect it and to predict extubation success or failure in mechanically ventilated patients. Besides, it would also be useful in differential diagnosis of dyspnea and respiratory failure. Aim of work :The aim of work is to evaluate usefulness and accuracy of ultrasound in assessment of DD in intensive care unit (ICU) patients in comparison with clinical outcome of patients.. In this prospective study, we compared the performance of ultrasound in visualization of diaphragm, detection of paradoxical movement, measurement of tidal and maximal thickness, and excursion, and calculation of thickening fraction (TF) of the diaphragm in quiet breathing. Patients and Method: The present study was performed on50 patients (26 males and 24 females) admitted in RICU in Benha university hospital The field study was conducted from March 2019 to September 2019. Ultrasound of the Rt, hemidiaphragm was done on the day of admission or soon after admission (1-2) days. Results: there was no statistical significant difference between the studied groups regarding ultrasound measurement (DTF, DE and DT) and patient outcome with p value (0.273,0.245 and 0.497)respectively .Conclusion: ultrasound of diaphragm in ICU patients may be a reliable, noninvasive and convenient way to assess the DD in ICU patients to predict their outcome.

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“…In this work there was no statistical significant difference between the studied Also, these results are not going with (16).…”

Section: Discussioncontrasting

confidence: 55%

The Role of Ultrasound in Assessment of Diaphragmatic Dysfunction in I.C.U Patients

Alshaer¹,

Elsheikh

Shaalan

et al. 2020

Benha Medical Journal

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“…Using the same cutoff, no association was found between diaphragm dysfunction and extubation failure [51]. Interestingly, when diaphragm excursion is measured after 30 min from initiation of a 2 h SBT, predictive performance of 10 mm cutoff seems to be significantly higher (AUROC 0.88) [52]. 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].…”

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%

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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“…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%

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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Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients

Cited by 117 publications

References 47 publications

The Role of Ultrasound in Assessment of Diaphragmatic Dysfunction in I.C.U Patients

The Role of Ultrasound in Assessment of Diaphragmatic Dysfunction in I.C.U Patients

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

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