Integrated ultrasound protocol in predicting weaning success and extubation failure: a prospective observational study

Kundu, Riddhi; Baidya, Dalim Kumar; Anand, Rahul; Maitra, Souvik; Soni, Kapil Dev; Subramanium, Rajeshwari

doi:10.5114/ait.2022.115351

Cited by 13 publications

(11 citation statements)

References 36 publications

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“…These findings were also supported by other studies included in a pooled data analysis of a systematic review [44]. In addition, the application of LUS combined with diaphragm [45] or diaphragm and cardiac sonography [46 ▪ ] showed a contrasting result requiring further investigations.…”

Section: Lung Ultrasonography Diagnostic Accuracy and Patients’ Outcomessupporting

confidence: 73%

Lung ultrasound monitoring: impact on economics and outcomes

Cammarota¹,

Vetrugno

Longhini³

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThis review aims to summarize the impact of lung ultrasonography (LUS) on economics and possible impact on patients’ outcomes, proven its diagnostic accuracy in patients with acute respiratory failure.Recent findingsDespite some previous ethical concerns on LUS examination, today this technique has showed several advantages. First, it is now clear that the daily use of LUS can provide a relevant cost reduction in healthcare of patients with acute respiratory failure, while reducing the risk of transport of patients to radiological departments for chest CT scan. In addition, LUS reduces the exposition to x-rays since can replace the bedside chest X-ray examination in many cases. Indeed, LUS is characterized by a diagnostic accuracy that is even superior to portable chest X-ray when performed by well trained personnel. Finally, LUS examination is a useful tool to predict the course of patients with pneumonia, including the need for hospitalization and ICU admission, noninvasive ventilation failure and orotracheal intubation, weaning success, and mortality.SummaryLUS should be implemented not only in Intensive Care Units, but also in other setting like emergency departments. Since most data comes from the recent coronavirus disease 2019 pandemic, further investigations are required in Acute Respiratory Failure of different etiologies.

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Section: Lung Ultrasonography Diagnostic Accuracy and Patients’ Outcomessupporting

confidence: 73%

Lung ultrasound monitoring: impact on economics and outcomes

Cammarota¹,

Vetrugno

Longhini³

2022

Current Opinion in Anaesthesiology

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“…At a fixed value of 80% for specificity to predict weaning failure, the estimated values of sensitivity were 61% (95% CI 44–75%) for PImax, 78% (95% CI 63–88%) for DTF and 76% (95% CI 64–85%) for DE. SROC curves of PImax ( n = 7 studies) [ 26 , 27 , 29 , 30 , 33 , 36 , 38 ], DTF ( n = 23 studies) [ 38 , 47 – 52 , 62 , 65 , 67 , 69 , 71 – 73 , 75 , 88 , 89 , 93 , 94 , 96 , 98 , 101 ], DE( n = 23 studies) [ 6 , 26 , 30 , 42 , 47 – 52 , 60 , 62 , 64 , 65 , 67 – 75 ] and P0.1 ( n = 11 studies) [ 29 , 36 , 73 , 102 – 106 , 108 – 110 ], Tdi ee ( n = 4 studies) [ 48 , 73 , 89 , 100 ] and Tdi ei ( n = 4 studies) [ 48 , 73 , 89 , 100 ] were estimated (Additional file 1 : Fig. S6 and Table S7).…”

Section: Resultsmentioning

confidence: 99%

Accuracy of respiratory muscle assessments to predict weaning outcomes: a systematic review and comparative meta-analysis

Poddighe,

Van Hollebeke,

Choudhary

et al. 2024

Crit Care

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Background Several bedside assessments are used to evaluate respiratory muscle function and to predict weaning from mechanical ventilation in patients on the intensive care unit. It remains unclear which assessments perform best in predicting weaning success. The primary aim of this systematic review and meta-analysis was to summarize and compare the accuracy of the following assessments to predict weaning success: maximal inspiratory (PImax) and expiratory pressures, diaphragm thickening fraction and excursion (DTF and DE), end-expiratory (Tdiee) and end-inspiratory (Tdiei) diaphragm thickness, airway occlusion pressure (P0.1), electrical activity of respiratory muscles, and volitional and non-volitional assessments of transdiaphragmatic and airway opening pressures. Methods Medline (via Pubmed), EMBASE, Web of Science, Cochrane Library and CINAHL were comprehensively searched from inception to 04/05/2023. Studies including adult mechanically ventilated patients reporting data on predictive accuracy were included. Hierarchical summary receiver operating characteristic (HSROC) models were used to estimate the SROC curves of each assessment method. Meta-regression was used to compare SROC curves. Sensitivity analyses were conducted by excluding studies with high risk of bias, as assessed with QUADAS-2. Direct comparisons were performed using studies comparing each pair of assessments within the same sample of patients. Results Ninety-four studies were identified of which 88 studies (n = 6296) reporting on either PImax, DTF, DE, Tdiee, Tdiei and P0.1 were included in the meta-analyses. The sensitivity to predict weaning success was 63% (95% CI 47–77%) for PImax, 75% (95% CI 67–82%) for DE, 77% (95% CI 61–87%) for DTF, 74% (95% CI 40–93%) for P0.1, 69% (95% CI 13–97%) for Tdiei, 37% (95% CI 13–70%) for Tdiee, at fixed 80% specificity. Accuracy of DE and DTF to predict weaning success was significantly higher when compared to PImax (p = 0.04 and p < 0.01, respectively). Sensitivity and direct comparisons analyses showed that the accuracy of DTF to predict weaning success was significantly higher when compared to DE (p < 0.01). Conclusions DTF and DE are superior to PImax and DTF seems to have the highest accuracy among all included respiratory muscle assessments for predicting weaning success. Further studies aiming at identifying the optimal threshold of DTF to predict weaning success are warranted. Trial registration: PROSPERO CRD42020209295, October 15, 2020.

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“… 4 Integrated LUS which is a 40-point score could have been a better indicator of lung condition, thus a better predictor of extubation readiness. 5 Upper airway obstruction is also one of the major causes of extubation failure. 6 Incorporation of the upper airway into the LUS score/integrated LUS score would have been more beneficial.…”

mentioning

confidence: 99%