Diaphragmatic Dynamics Assessed by Bedside Ultrasound Predict Extubation in the Intensive Care Unit: A Prospective Observational Study
Tianjie Zhang,1 Yan Liu,1 Dongwei Xu,2 Rui Dong,1 Ye Song1 1Department of Ultrasonography, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318,People’s Republic of China; 2Department of Critical Care Medicine, Shanghai University of Medicine and Health Sc...
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2024-11-01
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| author | Zhang T Liu Y Xu D Dong R Song Y |
| author_facet | Zhang T Liu Y Xu D Dong R Song Y |
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| description | Tianjie Zhang,1 Yan Liu,1 Dongwei Xu,2 Rui Dong,1 Ye Song1 1Department of Ultrasonography, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318,People’s Republic of China; 2Department of Critical Care Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, People’s Republic of ChinaCorrespondence: Ye Song, Email songy_18@sumhs.edu.cnBackground: This study aims to evaluate the predictive value of bedside ultrasound evaluation of diaphragmatic dynamics in determining successful extubation outcomes for patients eligible for weaning.Methods: This prospective observational study was conducted on patients who were mechanically ventilated and ready for weaning during the spontaneous breathing trial (SBT). The diaphragm contraction and motion-related parameters of patients such as end inspiratory diaphragm thickness (DT-insp), end respiratory diaphragm thickness (DT-exp), diaphragm thickening fraction (DTF), diaphragmatic thickening fraction rapid shallow breathing index (DTF-RSBI), diaphragmatic excursion (DE), diaphragmatic excursion rapid shallow breathing index (DE-RSBI) were recorded and the association with failure in ventilatory extubation was analyzed. A receiver operating characteristic (ROC) curve was conducted to analyze the prediction of successful weaning.Results: Out of 95 patients, 14 (14.74%) died, and 68 (71.58%) were successfully extubated. There were significant differences between the two groups in all parameters except DT-exp. The results indicated that duration of mechanical ventilation (OR = 0.850, 95% CI: 0.770– 0.938, P = 0.001), DTF (OR = 1.214, 95% CI: 1.108– 1.330, P = 0.000), DTF-RSBI (OR = 0.917, 95% CI: 0.880– 0.954, P = 0.000), DE (OR = 127.02, 95% CI: 15.004– 1075.291, P = 0.000), DE-RSBI (OR = 0.752, 95% CI: 0.657– 0.861, P = 0.000) had predictive value for weaning. DTF and DE had a high sensitivity of 91.18%, 100%, respectively. Whereas, duration of mechanical ventilation, DTF-RSBI, DE-RSBI showed a high specificity of 81.48,85.19%, 81.48%. Considering all the above factors, the sensitivity was 88.24% and the specificity was 88.89%.Conclusion: Bedside ultrasound assessment of diaphragmatic parameters enables the detection of diaphragmatic dysfunction, thus proving valuable in predicting extubation success and facilitating a favorable weaning outcome.Keywords: diaphragmatic dynamics, bedside ultrasound, extubation, intensive care unit |
| format | Article |
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| institution | Kabale University |
| issn | 1178-7074 |
| language | English |
| publishDate | 2024-11-01 |
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| spelling | doaj-art-d6743b46b821427a8f60942b09458da92024-11-19T16:55:51ZengDove Medical PressInternational Journal of General Medicine1178-70742024-11-01Volume 175373538097400Diaphragmatic Dynamics Assessed by Bedside Ultrasound Predict Extubation in the Intensive Care Unit: A Prospective Observational StudyZhang TLiu YXu DDong RSong YTianjie Zhang,1 Yan Liu,1 Dongwei Xu,2 Rui Dong,1 Ye Song1 1Department of Ultrasonography, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318,People’s Republic of China; 2Department of Critical Care Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, People’s Republic of ChinaCorrespondence: Ye Song, Email songy_18@sumhs.edu.cnBackground: This study aims to evaluate the predictive value of bedside ultrasound evaluation of diaphragmatic dynamics in determining successful extubation outcomes for patients eligible for weaning.Methods: This prospective observational study was conducted on patients who were mechanically ventilated and ready for weaning during the spontaneous breathing trial (SBT). The diaphragm contraction and motion-related parameters of patients such as end inspiratory diaphragm thickness (DT-insp), end respiratory diaphragm thickness (DT-exp), diaphragm thickening fraction (DTF), diaphragmatic thickening fraction rapid shallow breathing index (DTF-RSBI), diaphragmatic excursion (DE), diaphragmatic excursion rapid shallow breathing index (DE-RSBI) were recorded and the association with failure in ventilatory extubation was analyzed. A receiver operating characteristic (ROC) curve was conducted to analyze the prediction of successful weaning.Results: Out of 95 patients, 14 (14.74%) died, and 68 (71.58%) were successfully extubated. There were significant differences between the two groups in all parameters except DT-exp. The results indicated that duration of mechanical ventilation (OR = 0.850, 95% CI: 0.770– 0.938, P = 0.001), DTF (OR = 1.214, 95% CI: 1.108– 1.330, P = 0.000), DTF-RSBI (OR = 0.917, 95% CI: 0.880– 0.954, P = 0.000), DE (OR = 127.02, 95% CI: 15.004– 1075.291, P = 0.000), DE-RSBI (OR = 0.752, 95% CI: 0.657– 0.861, P = 0.000) had predictive value for weaning. DTF and DE had a high sensitivity of 91.18%, 100%, respectively. Whereas, duration of mechanical ventilation, DTF-RSBI, DE-RSBI showed a high specificity of 81.48,85.19%, 81.48%. Considering all the above factors, the sensitivity was 88.24% and the specificity was 88.89%.Conclusion: Bedside ultrasound assessment of diaphragmatic parameters enables the detection of diaphragmatic dysfunction, thus proving valuable in predicting extubation success and facilitating a favorable weaning outcome.Keywords: diaphragmatic dynamics, bedside ultrasound, extubation, intensive care unithttps://www.dovepress.com/diaphragmatic-dynamics-assessed-by-bedside-ultrasound-predict-extubati-peer-reviewed-fulltext-article-IJGMdiaphragmatic dynamicsbedside ultrasoundextubationintensive care unit |
| spellingShingle | Zhang T Liu Y Xu D Dong R Song Y Diaphragmatic Dynamics Assessed by Bedside Ultrasound Predict Extubation in the Intensive Care Unit: A Prospective Observational Study International Journal of General Medicine diaphragmatic dynamics bedside ultrasound extubation intensive care unit |
| title | Diaphragmatic Dynamics Assessed by Bedside Ultrasound Predict Extubation in the Intensive Care Unit: A Prospective Observational Study |
| title_full | Diaphragmatic Dynamics Assessed by Bedside Ultrasound Predict Extubation in the Intensive Care Unit: A Prospective Observational Study |
| title_fullStr | Diaphragmatic Dynamics Assessed by Bedside Ultrasound Predict Extubation in the Intensive Care Unit: A Prospective Observational Study |
| title_full_unstemmed | Diaphragmatic Dynamics Assessed by Bedside Ultrasound Predict Extubation in the Intensive Care Unit: A Prospective Observational Study |
| title_short | Diaphragmatic Dynamics Assessed by Bedside Ultrasound Predict Extubation in the Intensive Care Unit: A Prospective Observational Study |
| title_sort | diaphragmatic dynamics assessed by bedside ultrasound predict extubation in the intensive care unit a prospective observational study |
| topic | diaphragmatic dynamics bedside ultrasound extubation intensive care unit |
| url | https://www.dovepress.com/diaphragmatic-dynamics-assessed-by-bedside-ultrasound-predict-extubati-peer-reviewed-fulltext-article-IJGM |
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