Parasternal intercostal muscle thickening as a predictor of non-invasive ventilation failure in patients with COVID-19

Helmy, Mina Adlof; Hasanin, Ahmed; Milad, Lydia Magdy; Mostafa, Maha; Fathy, Shaimaa

doi:10.1016/j.accpm.2022.101063

Cited by 3 publications

(4 citation statements)

References 5 publications

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“…The increased intercostal muscle activity, as a compensatory mechanism to the reduced diaphragmatic activity [9], lead to the interest in the use of the PIC TF as a simple surrogate to the diaphragmatic excursion. The PIC TF was previously found to be able to predict failure of non-invasive ventilation in patients with COVID-19 with comparable accuracy to diaphragmatic excursion and the advantage of being easier [5]. In this study we report a novel application of intercostal muscle ultrasound as an accurate marker of severity in the early phases of the disease and interestingly, we found that the cut-off values of the PIC TF were close to our previous study [5].…”

Section: Discussionsupporting

confidence: 82%

“…The PIC TF was previously found to be able to predict failure of non-invasive ventilation in patients with COVID-19 with comparable accuracy to diaphragmatic excursion and the advantage of being easier [5]. In this study we report a novel application of intercostal muscle ultrasound as an accurate marker of severity in the early phases of the disease and interestingly, we found that the cut-off values of the PIC TF were close to our previous study [5]. Furthermore, the PIC TF values in subjects who had unfavorable outcome in this study (median [quartiles]: 16 [11,27]% for need for ventilatory support and 22 [13,29]% for the composite outcome) are close to that reported by Dres et al in non-COVID-19 patients with failed spontaneous breathing trial (median [quartiles]: 18 [10, 33]%) [9].…”

Section: Discussionmentioning

confidence: 99%

“…Several methods for risk stratification had been reported such as computed tomography (CT) scan, clinical variables, and laboratory markers; however, none of them fulfilled the requirements of the ideal variable. There had been increased interest in ultrasonographic assessment of the activity of the diaphragm and other respiratory muscles as predictors of patient outcomes [5][6][7]. Ultrasound evaluation of the respiratory muscles carries several advantages, such as being a bedside tool, simple, economic and devoid of ionizing radiation [8].…”

Section: Introductionmentioning

confidence: 99%

“…Being non-invasive and easily accessible, parasternal intercostal (PIC) muscle ultrasound has gained interest as a tool for evaluating the respiratory function [9] and showed excellent accuracy in predicting non-invasive ventilation failure [5].…”

Section: Introductionmentioning

confidence: 99%

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Parasternal intercostal thickening at hospital admission: a promising indicator for mechanical ventilation risk in subjects with severe COVID-19

Helmy

Milad

Hasanin

et al. 2023

J Clin Monit Comput

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We aimed to evaluate the ability of parasternal intercostal thickening fraction (PIC TF) to predict the need for mechanical ventilation, and survival in subjects with severe Coronavirus disease-2019 (COVID-19). This prospective observational study included adult subjects with severe COVID-19. The following data were collected within 12 h of admission: PIC TF, respiratory rate oxygenation index, $${{{\text{P}}_{{{\text{aO}}_{{\text{2}}} }} } \mathord{\left/ {\vphantom {{{\text{P}}_{{{\text{aO}}_{{\text{2}}} }} } {{\text{F}}_{{{\text{iO}}_{{\text{2}}} }} }}} \right. \kern-\nulldelimiterspace} {{\text{F}}_{{{\text{iO}}_{{\text{2}}} }} }}$$ P aO 2 / F iO 2 ratio, chest CT, and acute physiology and chronic health evaluation II score. The ability of PIC TF to predict the need for ventilatory support (primary outcome) and a composite of invasive mechanical ventilation and/or 30-days mortality were performed using the area under the receiver operating characteristic (AUC) analysis. Multivariate analysis was done to identify the independent predictors for the outcomes. Fifty subjects were available for the final evaluation. The AUC (95% confidence interval [CI]) for the right and left PIC TF ability to predict the need for ventilator support was 0.94 (0.83–0.99), 0.94 (0.84–0.99), respectively, with a cut off value of > 8.3% and positive predictive value of 90–100%. The AUC for the right and left PIC TF to predict invasive mechanical ventilation and/or 30 days mortality was 0.95 (0.85–0.99) and 0.90 (0.78–0.97), respectively. In the multivariate analysis, only the PIC TF was found to independently predict invasive mechanical ventilation and/or 30-days mortality. In subjects with severe COVID-19, PIC TF of 8.3% can predict the need to ventilatory support with a positive predictive value of 90–100%. PIC TF is an independent risk factor for the need for invasive mechanical ventilation and/or 30-days mortality.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Parasternal intercostal thickening at hospital admission: a promising indicator for mechanical ventilation risk in subjects with severe COVID-19

Helmy

Milad

Hasanin

et al. 2023

J Clin Monit Comput

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Assessment of Respiratory Muscles, Lung Parenchyma, and Cardiac Function by Ultrasound for Predicting Weaning Failure in Critically Ill Adults

Kannan,

Khanna,

Kayarat

et al. 2024

J of Ultrasound Medicine

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ObjectivesThe parasternal intercostal muscle activity, a marker of accessory muscle usage, is found to correlate inversely with the pressure‐generating capacity of the diaphragm and level of support of mechanical ventilation. The primary objective of our study was to determine whether the parasternal intercostal muscle thickening fraction (PMTF) measured by ultrasonography can predict weaning. We also evaluated whether addition of lung ultrasound score and echocardiographic assessment can add on to predicting weaning failure.MethodsThis prospective observational study conducted in a mixed medical‐surgical intensive care unit, included 60 adult patients who were eligible for a spontaneous breathing trial (SBT) after being invasively mechanically ventilated for more than 48 hours. Ultrasound of respiratory muscles, lung parenchyma, and echocardiographic assessment were performed before and after 120 minutes of SBT. Parasternal intercostal muscles were imaged with a high frequency linear probe on the right second intercostal space 5 cm lateral to the sternal margin. PMTF was calculated as (maximum‐minimum thickness)/minimum thickness.ResultsAmong 60 patients, SBT failure was seen in 11 patients and extubation failed in 8 patients. PMTF (%) was significantly higher in the weaning failure group (13.33 [8.33–19.05]) as compared to patients with successful weaning (6.67 [6.06–11.54]). Diaphragmatic thickening fraction (DTF) correlated inversely to PMTF in patients with weaning failure. A pre‐SBT PMTF cut‐off of ≥7.7% and post‐SBT cut‐off of ≥15.38% were good predictors of weaning failure and extubation failure, respectively.ConclusionsPMTF has good discriminatory power to predict weaning outcomes (area under the receiver operating characteristic curve: 0.74 [0.59–0.88]). Pre‐SBT PMTF had similar power as DTF to predict weaning failure.

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Ability of parasternal intercostal muscle thickening fraction to predict reintubation in surgical patients with sepsis

Helmy,

Hasanin,

Milad

et al. 2024

BMC Anesthesiol

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Objectives We aimed to evaluate the ability of the parasternal intercostal (PIC) thickening fraction during spontaneous breathing trial (SBT) to predict the need for reintubation within 48 h after extubation in surgical patients with sepsis. Methods This prospective observational study included adult patients with sepsis who were mechanically ventilated and indicated for SBT. Ultrasound measurements of the PIC thickening fraction and diaphragmatic excursion (DE) were recorded 15 min after the start of the SBT. After extubation, the patients were followed up for 48 h for the need for reintubation. The study outcomes were the ability of the PIC thickening fraction (primary outcome) and DE to predict reintubation within 48 h of extubation using area under receiver characteristic curve (AUC) analysis. The accuracy of the model including the findings of right PIC thickening fraction and right DE was also assessed using the current study cut-off values. Multivariate analysis was performed to identify independent risk factors for reintubation. Results We analyzed data from 49 patients who underwent successful SBT, and 10/49 (20%) required reintubation. The AUCs (95% confidence interval [CI]) for the ability of right and left side PIC thickening fraction to predict reintubation were 0.97 (0.88–1.00) and 0.96 (0.86–1.00), respectively; at a cutoff value of 6.5–8.3%, the PIC thickening fraction had a negative predictive value of 100%. The AUCs for the PIC thickening fraction and DE were comparable; and both measures were independent risk factors for reintubation. The AUC (95% CI) of the model including the right PIC thickening fraction > 6.5% and right DE ≤ 18 mm to predict reintubation was 0.99 (0.92–1.00), with a positive predictive value of 100% when both sonographic findings are positive and negative predictive value of 100% when both sonographic findings are negative. Conclusions Among surgical patients with sepsis, PIC thickening fraction evaluated during the SBT is an independent risk factor for reintubation. The PIC thickening fraction has an excellent predictive value for reintubation. A PIC thickening fraction of ≤ 6.5–8.3% can exclude reintubation, with a negative predictive value of 100%. Furthermore, a combination of high PIC and low DE can also indicate a high risk of reintubation. However, larger studies that include different populations are required to replicate our findings and validate the cutoff values.

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Parasternal intercostal muscle thickening as a predictor of non-invasive ventilation failure in patients with COVID-19

Cited by 3 publications

References 5 publications

Parasternal intercostal thickening at hospital admission: a promising indicator for mechanical ventilation risk in subjects with severe COVID-19

Parasternal intercostal thickening at hospital admission: a promising indicator for mechanical ventilation risk in subjects with severe COVID-19

Assessment of Respiratory Muscles, Lung Parenchyma, and Cardiac Function by Ultrasound for Predicting Weaning Failure in Critically Ill Adults

Ability of parasternal intercostal muscle thickening fraction to predict reintubation in surgical patients with sepsis

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