Does diaphragm ultrasound improve the rapid shallow breathing index accuracy for predicting the success of weaning from mechanical ventilation?

Fossat, Guillaume; Daillet, Blanche; Desmalles, Emmanuelle; Boulain, Thierry

doi:10.1016/j.aucc.2021.05.008

Cited by 10 publications

(17 citation statements)

References 40 publications

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“…A meta-analysis of pooled data from 19 studies (24, 26, 27, 31–35, 42, 44, 49, 50, 58, 59, 61, 62, 64–66) found acceptable prediction of weaning outcome after 48 hours but with high heterogeneity due to the mixed patient population, varying imaging modes, and different time points at which measurements were done such as prior to SBT, during SBT, end of an SBT, postextubation, and during a pressure support weaning trial ± T-piece (AUC, 0.78) ( Fig. 2 C ).…”

Section: Resultsmentioning

confidence: 99%

“…DTF measurements were mainly made during both end inspiration and end expiration of tidal breathing (n = 33/36). Transducer placement was not reported for DTF in one study (27). Breathing pattern at time of assessment was not reported for DT and DTF in one study (36).…”

Section: Ultrasound Imaging Acquisition and Analysis Methodologymentioning

confidence: 99%

“…The most common diaphragm ultrasound parameter measured was DTF (n = 36/60), followed by diaphragm thickness (DT) (n = 35/60) and diaphragm excursion (DE) (n = 31/60). Thirteen individual studies assessed excursionderived measures including diaphragmatic rapid shallow breathing index (24)(25)(26), rapid shallow diaphragmatic index (27), excursion-time index (28,29), ULDIMex (28), peak contraction velocity (30,31), velocity-time integral (30), peak relaxation velocity (30), time-to-peak inspiratory amplitude (32), and contraction velocity (33)(34)(35)(36).…”

Section: Ultrasound Imaging Acquisition and Analysis Methodologymentioning

confidence: 99%

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Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis

Truong

Abo

Whish-Wilson

et al. 2023

Critical Care Medicine

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in the Critical Care Setting: A Systematic Review and Meta-Analysis OBJECTIVE: Significant variations exist in the use of respiratory muscle ultrasound in intensive care with no society-level consensus on the optimal methodology. This systematic review aims to evaluate, synthesize, and compare the clinimetric properties of different image acquisition and analysis methodologies.DATA SOURCES: Systematic search of five databases up to November 24, 2021. STUDY SELECTION:Studies were included if they enrolled at least 50 adult ICU patients, reported respiratory muscle (diaphragm or intercostal) ultrasound measuring either echotexture, muscle thickness, thickening fraction, or excursion, and evaluated at least one clinimetric property. Two independent reviewers assessed titles, abstracts, and full text against eligibility.DATA EXTRACTION: Study demographics, ultrasound methodologies, and clinimetric data.DATA SYNTHESIS: Sixty studies, including 5,025 patients, were included with 39 studies contributing to meta-analyses. Most commonly measured was diaphragm thickness (DT) or diaphragm thickening fraction (DTF) using a linear transducer in B-mode, or diaphragm excursion (DE) using a curvilinear transducer in M-mode. There are significant variations in imaging methodology and acquisition across all studies. Inter-and intrarater measurement reliabilities were generally excellent, with the highest reliability reported for DT (ICC, 0.98; 95% CI, 0.94-0.99). Pooled data demonstrated acceptable to excellent accuracy for DT, DTF, and DE to predicting weaning outcome after 48 to 72 hours postextubation (DTF AUC, 0.79; 95% CI, 0.73-0.85). DT imaging was responsive to change over time. Only three eligible studies were available for intercostal muscles. Intercostal thickening fraction was shown to have excellent accuracy of predicting weaning outcome after 48-hour postextubation (AUC, 0.84; 95% CI, 0.78-0.91). CONCLUSIONS:Diaphragm muscle ultrasound is reliable, valid, and responsive in ICU patients, but significant variation exists in the imaging acquisition and analysis methodologies. Future work should focus on developing standardized protocols for ultrasound imaging and consider further research into the role of intercostal muscle imaging.

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Section: Resultsmentioning

confidence: 99%

Section: Ultrasound Imaging Acquisition and Analysis Methodologymentioning

confidence: 99%

Section: Ultrasound Imaging Acquisition and Analysis Methodologymentioning

confidence: 99%

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Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis

Truong

Abo

Whish-Wilson

et al. 2023

Critical Care Medicine

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“…In the recent study [ 36 ], Fossat et al proposed a new composite index named the rapid shallow diaphragmatic index (RSDI) (RSBI/DE). During a 30-min SBT with minimal PSV (pressure support of 6 cm H 2 O and end-expiratory pressure of 0 cm H 2 O), the diaphragmatic ultrasonography was performed and the RSDI, RSBI was calculated at the 5th and the 25th minute of the SBT.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Background The optimum timing to wean is crucial to avoid negative outcomes for mechanically ventilated patients. The rapid shallow breathing index (RSBI), a widely used weaning index, has limitations in predicting weaning outcomes. By replacing the tidal volume of the RSBI with diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF) assessed by ultrasonography, we calculated two weaning indices, the diaphragmatic excursion rapid shallow breathing index (DE-RSBI, respiratory rate [RR]/DE) and the diaphragm thickening fraction rapid shallow breathing index (DTF-RSBI, RR/DTF). The aim of this study was to evaluate the predictive values of DTF-RSBI, DE-RSBI and traditional RSBI in weaning failure. Methods This prospective observational study included patients undergoing mechanical ventilation (MV) for > 48 h and who were readied for weaning. During a pressure support ventilation (PSV) spontaneous breathing trial (SBT), right hemidiaphragmatic excursion and DTF were measured by bedside ultrasonography as well as RSBI. Weaning failure was defined as: (1) failing the SBT and (2) SBT success but inability to maintain spontaneous breathing for more than 48 h without noninvasive or invasive ventilation. A receiver operator characteristic (ROC) curve was used for analyzing the diagnostic accuracy of RSBI, DE-RSBI, and DTF-RSBI. Results Of the 110 patients studied, 37 patients (33.6%) failed weaning. The area under the ROC (AUROC) curves for RSBI, DE-RSBI, and DTF-RSBI for predicting failed weaning were 0.639, 0.813, and 0.859, respectively. The AUROC curves for DE-RSBI and DTF-RSBI were significantly higher than for RSBI (P = 0.004 and P < 0.001, respectively). The best cut-off values for predicting failed weaning were RSBI > 51.2 breaths/min/L, DE-RSBI > 1.38 breaths/min/mm, and DTF-RSBI > 78.1 breaths/min/%. Conclusions In this study, two weaning indices determined by bedside ultrasonography, the DE-RSBI (RR/DE) and DTF-RSBI (RR/DTF), were shown to be more accurate than the traditional RSBI (RR/VT) in predicting weaning outcome during a PSV SBT.

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“…The AUROC was 0.422, which was similar to other studies. [ 24 - 26 ] The lower the cut-off value, the higher the predictability in RSBI. It has the advantage of considering the balance between respiratory load and effort.…”

Section: Discussionmentioning

confidence: 99%

Role of diaphragm ultrasound in weaning mechanically ventilated patients: A prospective observational study

Saravanan¹,

Nivedita²,

Karthik³

et al. 2022

Indian Journal of Anaesthesia

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Background and Aims: Weaning from mechanical ventilation based on clinical parameters and rapid shallow breathing index (RSBI) is associated with a higher weaning failure. Bedside ultrasound of the diaphragm is gaining popularity to assess the diaphragm function. The aim of our study was to determine the use of diaphragm ultrasound in weaning ventilated patients. Methods: This prospective study was done on 200 adult patients on mechanical ventilation for more than 24 h. After meeting the clinical weaning criteria, a spontaneous breathing trial (SBT) was performed. RSBI was recorded and a bedside ultrasound of the diaphragm was performed to measure diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF) before extubation. We assessed the predictability of weaning success of RSBI, DE and DTF by determining the area under the receiver operating characteristic (AUROC) curve and Youden’s index. The requirement of non-invasive ventilation or re-intubation within 48 h was considered a weaning failure. Results: Out of the 200 patients studied, 171 were successfully weaned. The AUROC values for RSBI, DTF, DE, RSBI-DTF and RSBI-DE for successful weaning prediction were 0.422, 0.654, 0.809, 0.656 and 0.807, respectively. The predictability using cut-off values were DE >1.21 cm (sensitivity 94%, specificity 71%, Youden’s index 0.65), DTF >37% (sensitivity 80%, specificity 52%, Youden’s index 0.31) and RSBI <82 (sensitivity 94%, specificity 31%, Youden’s index 0.25). Conclusion: Diaphragm ultrasound helps in predicting successful weaning in mechanically ventilated patients. Both DE and DTF showed a higher specificity than RSBI and a combination of RSBI-DE and RSBI-DTF was better than using RSBI alone.

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Does diaphragm ultrasound improve the rapid shallow breathing index accuracy for predicting the success of weaning from mechanical ventilation?

Cited by 10 publications

References 40 publications

Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis

Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis

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

Role of diaphragm ultrasound in weaning mechanically ventilated patients: A prospective observational study

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