The predictive value of combining diaphragmatic ultrasound with echocardiography in weaning from mechanical ventilation in critically ill patients

doi:10.3877/cma.j.issn.2096-1537.2021.01.005

Abstract

Abstract:

Objective

To evaluate the predictive value of combining diaphragmatic ultrasound with echocardiography in weaning from mechanical ventilation in critically ill patients.

Methods

Fifty six mechanical ventilated patients were enrolled in Intensive Care Unit of the First Hospital of Shanxi Medical University from June 2019 to June 2020. When meeting the standard of weaning from mechanical ventilation,spontaneous breathing test (SBT) would be carried out in these patients. During SBT, diaphragmatic excursion and cardiac diastolic function were measured with bedside ultrasound. The patients were divided into successfully weaning group and failed weaning group. Binary Logistic regression analysis and receiver operator characteristic curves (ROC curves) analysis were used to evaluate the predictive value of these two measurements.

Results

Of the 56 patients, 15 patients failed in weaning procedure. A cut-off value of diaphragmatic excursion less than 12.4 mm was associated with weaning failure with the AUC of 0.797, a sensitivity of 88% and specificity of 67%. The AUC of E/e' value was 0.787, and a cut-off value =11.9 showed the highest diagnostic accuracy with a sensitivity of 95% and specificity of 67% respectively. The AUC of diaphragmatic excursion combined with E/e' value was 0.866, with a sensitivity of 83% and specificity of 87% respectively.

Conclusion

Diaphragmatic excursion and E/e' can be used as clinical parameters to predict weaning success.Combining diaphragmatic excursion with E/e' could increase predicting accuracy in weaning failure.

Key words: Weaning, Diaphragmatic ultrasound, Diaphragmatic excursion, Echocardiography, Left ventricular diastolic function

Menglei Zhu, Hong Liu, Jibin Han, Xiadi Wei. The predictive value of combining diaphragmatic ultrasound with echocardiography in weaning from mechanical ventilation in critically ill patients[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(01): 28-32.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2021.01.005

https://icu.cma-cmc.com.cn/EN/Y2021/V07/I01/28

Figures/Tables 2

组别	年龄（岁， $x ¯$ ±s）	性别（男，例）	BMI（kg/m²， $x ¯$ ±s）	APACHE Ⅱ评分[分，M（P₂₅，P₇₅）]	SOFA评分[分，M（P₂₅，P₇₅）]	插管时间[h，M（P₂₅，P₇₅）]
脱机失败组（15例）	52.00±15.20	9	24.81±1.36	13（12，15）	4（4，6）	175（162，190）
脱机成功组（41例）	50.02±13.75	27	24.18±0.82	13（11.5，16.5）	4（3，5）	170（159.5，176）
统计值	t=0.463	χ²=0.164	t=2.118	u=0.056	u=-1.171	u=-1.324
P值	0.645	0.686	0.039	0.955	0.242	0.186
组别	pH[M（P₂₅，P₇₅）]	PaCO₂[mmHg，M（P₂₅，P₇₅）]	PaO₂（mmHg， $x ¯$ ±s）	LVEF（%， $x ¯$ ±s）	E/e'（ $x ¯$ ±s）	DE（mm， $x ¯$ ±s）
脱机失败组（15例）	7.41（7.39，7.42）	41.2（38.2，42.7）	91.96±8.35	55.87±8.23	12.87±2.93	11.56±1.77
脱机成功组（41例）	7.40（7.39，7.43）	39.2（38.6，42.7）	93.80±5.43	55.63±5.99	10.07±1.22	13.34±0.98
统计值	u=-0.337	u=-0.658	t=-0.965	t=0.116	t=5.097	t=-4.787
P值	0.736	0.510	0.339	0.908	＜0.001	＜0.001

组别	年龄（岁， $x ¯$ ±s）	性别（男，例）	BMI（kg/m²， $x ¯$ ±s）	APACHE Ⅱ评分[分，M（P₂₅，P₇₅）]	SOFA评分[分，M（P₂₅，P₇₅）]	插管时间[h，M（P₂₅，P₇₅）]
脱机失败组（15例）	52.00±15.20	9	24.81±1.36	13（12，15）	4（4，6）	175（162，190）
脱机成功组（41例）	50.02±13.75	27	24.18±0.82	13（11.5，16.5）	4（3，5）	170（159.5，176）
统计值	t=0.463	χ²=0.164	t=2.118	u=0.056	u=-1.171	u=-1.324
P值	0.645	0.686	0.039	0.955	0.242	0.186
组别	pH[M（P₂₅，P₇₅）]	PaCO₂[mmHg，M（P₂₅，P₇₅）]	PaO₂（mmHg， $x ¯$ ±s）	LVEF（%， $x ¯$ ±s）	E/e'（ $x ¯$ ±s）	DE（mm， $x ¯$ ±s）
脱机失败组（15例）	7.41（7.39，7.42）	41.2（38.2，42.7）	91.96±8.35	55.87±8.23	12.87±2.93	11.56±1.77
脱机成功组（41例）	7.40（7.39，7.43）	39.2（38.6，42.7）	93.80±5.43	55.63±5.99	10.07±1.22	13.34±0.98
统计值	u=-0.337	u=-0.658	t=-0.965	t=0.116	t=5.097	t=-4.787
P值	0.736	0.510	0.339	0.908	＜0.001	＜0.001

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