Dyspnoea and respiratory muscle ultrasound to predict extubation failure

Abstract

This study investigated dyspnea intensity and respiratory muscles ultrasound early after extubation to predict extubation failure.It was conducted prospectively in two intensive care units in France and Canada. Patients intubated for at least 48 h were studied within 2 h after an extubation following a successful spontaneous breathing trial. Dyspnea was evaluated by the Dyspnea-Visual Analog Scale from 0 to 10 cm (VAS) and the Intensive Care - Respiratory Distress Observational Scale (range 0–10). The ultrasound thickening fraction of the parasternal intercostal and the diaphragm were measured; limb muscle strength was evaluated using the Medical Research Council score (MRC) (range 0–60).Extubation failure occurred in 21 of the 122 enrolled patients (17%). Dyspnea-VAS and Intensive Care - Respiratory Distress Observational scale were higher in patients with extubation failure versus success: 7 (5–9) cm versus 3 (1–5) cm respectively (p<0.001) and 4.4 (2.5–6.5) versus 2.4 (2.1–2.8) respectively (p<0.001). The ratio of intercostal muscle to diaphragm thickening fraction was significantly higher and MRC was lower in patients with failure (0.9 [0.4–3.0] versus 0.3 [0.2–0.5], p<0.001, and 45 [36–50] versus 52 [44–60], p=0.012). The thickening fraction of the intercostal and its ratio to diaphragm thickening showed the highest area under the receiver operating characteristic curves for an early prediction of extubation failure (0.81). Areas under the receiver operating characteristic curves of Dyspnea-VAS and Intensive Care - Respiratory Distress Observational scale reached 0.78 and 0.74 respectively.Respiratory muscle ultrasound and dyspnea measured within 2 h after extubation predict subsequent extubation failure.

Phenotypes of Patients with COVID-19 Who Have a Positive Clinical Response to Helmet Noninvasive Ventilation

“…Our study has limitations: The post hoc nature of these analyses and the small sample make the results hypothesis generating, warranting further confirmatory investigations; the thresholds proposed should be taken cautiously; and VAS dyspnea is mainly used to compare dyspnea within a subject before and after a stimulus is applied, but it has been recently used to compare subjects undergoing noninvasive support ( 4 , 5 ). We believe that its application in the present investigation is legitimate.…”

“…Pa O 2 /F i O 2 , Pa CO 2 , and VAS dyspnea were measured while patients were receiving Venturimask oxygen before randomization. VAS dyspnea was assessed by visual analog scale, ranging from 0 to 10, with 10 representing the worst symptom ( 4 , 5 ). For patients with VAS dyspnea = 0, Pa O 2 /(F i O 2 × VAS dyspnea) was considered equal to Pa O 2 /F i O 2 .…”

Chronic obstructive pulmonary disease assessment test for the measurement of deterioration and recovery of health status of patients undergoing lung surgery

“… 14 Patients with respiratory muscle dysfunction cannot generate adequate strength to drive ventilation and often have lower V T , which causes more dyspnea and unstable V T during exercise. 16 Therefore, when respiratory muscle weakness develops, symptoms progress to dyspnea, tachypnea, and paradoxical respiration. 17 We found that the decrease in the MIP of patients who underwent lobectomy was greater than that of patients who underwent wedge resection, which is consistent with the reduction in V T during exercise in patients who underwent lobectomy.…”

Respiratory distress observation scales to predict weaning outcome

“…This can typically result from an unfavorable respiratory system load-capacity balance, as it occurs in cases of SBT failure [ 10 ]. The association between dyspnea and SBT failure has indeed been reported [ 11 – 15 ], as well as post-extubation dyspnea is predictive of extubation failure [ 16 ].…”