Role of ultrasound in assessment of diaphragmatic function in chronic obstructive pulmonary disease patients during weaning from mechanical ventilation

Abstract

ObjectivesThe aim of the study was to investigate the role of ultrasound in the evaluation of movement of the diaphragm and its value in predicting successful extubation in mechanically ventilated chronic obstructive pulmonary disease (COPD) patients in relation to other weaning parameters. Patients and methodsThe present study was conducted on 50 patients in the respiratory ICU and the Chest Department of Ain Shams University Hospitals. Patients were divided into two groups: group A and group B. Group A consisted of 30 mechanically ventilated COPD patients admitted to the respiratory ICU and group B consisted of 20 COPD patients not mechanically ventilated during attendance at the Chest Department. ResultsDiaphragmatic movement was assessed in the two groups. The mean value of diaphragmatic displacement was higher in group B. In group A this value was higher among those with successful weaning using a cutoff value of 1.1 cm with sensitivity of 86.4%, specificity of 87.5%, and accuracy of 89.5%. There was a significant correlation between diaphragmatic displacement and other weaning parameters, which was better in the group with successful weaning. Conclusion Diaphragmatic displacement measuredby ultrasound is one of the most sensitive, specific, and accurate parameters for weaning of COPD patients from mechanical ventilation, especially in relationship with other weaning parameters.

Diaphragm and Lung Ultrasound Indices in Prediction of Outcome of Weaning from Mechanical Ventilation in Pediatric Intensive Care Unit

“…By applying diaphragmatic US to those patients during SBT, authors found that during infancy period the measured DTF, diaphragmatic excursion and the total lung score showed highly significant correlations with weaning outcome (p < 0.001). These results were matched with results of several studies [16][17][18][19].…”

“…This agrees with results of other studies which reported that the cut-off value of Diaphragmatic E in the assessment of the weaning outcome is 10-11 mm with different degrees of sensitivity and specificity. Saeed et al [16] stated that it has 86.4% sensitivity and 87.5% specificity while Baess et al stated that it has 69.5% sensitivity and 71.4% specificity [14].…”

Diaphragm ultrasound to predict weaning outcome: systematic review and meta-analysis

“…Of these, 24 articles were excluded for the following reasons: ten studies were not primary studies, five studies evaluated diaphragm muscle atrophy, two studies used phrenic nerve stimulation rather than ultrasonography, two studies only reported ultrasonography examination reproducibility, one study evaluated patients under MV, one evaluated only patients with high risk of reintubation and three studies were conducted on children or non-mechanically ventilated patients. Therefore, 19 studies were evaluated in the final analysis [15,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. Included studies' quality assessed by the QUADAS II tool are shown in Table 1.…”

“…DE was assessed in 701 patients enrolled in eleven studies [15,25,26,[30][31][32][33][34][36][37][38] during spontaneous breathing. The pooled sensitivity and specificity were 79.9% (I 2 = 65.3%) and 69% (I 2 = 75.1%), respectively, with DOR of 9.1 (I 2 = 59.1%).…”

ICU outcomes can be predicted by noninvasive muscle evaluation: a meta-analysis

“…Of these, 46 were included (Figure 1). [3,5,8,11,13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Some of these 46 articles evaluated more than one diagnostic test, therefore the final analysis included evaluation data from 60 separate studies on a total of 1. Of the 60 studies, 23 evaluated respiratory muscle strength using diaphragm ultrasound (1390 patients), [3, 13, 15-18, 24, 26-28, 36-48] 6 used transdiaphragmatic twitch pressure (292 patients) [3,5,11,13,49,50] and 13 used MIP (709 patients) [3, 15-17, 25-28, 51-55].…”