Landeros YJCC

Language: Spanish
References: 21
Page: 686-690
PDF size: 216.57 Kb.

ABSTRACT

Introduction: the diaphragm is the main respiratory muscle and its dysfunction in critically ill patients favors the development of respiratory complications, thereby increasing the days of mechanical ventilation. Objective: to determine the correlation of diaphragmatic function measured by ultrasound in comparison with negative inspiratory force (NIF), as predictors of ventilatory weaning in critically ill patients in the Intensive Care Unit. Material and methods: comparative study of diagnostic accuracy, observational, longitudinal, prospective, diaphragmatic excursion was measured with ultrasound upon admission and daily until withdrawal of mechanical ventilation; additionally, time to peak inspiratory amplitude of the diaphragm (TPIA) and NIF was measured. Withdrawal was considered successful when ventilatory support was not required again for a period of 48 hours. Results: 50 patients were included: surgical and non-surgical neurological 23 (46%), non-cardiothoracic post-surgical 11 (22%), infectious nine (18%), cardiothoracic post-surgical five (10%) and primary respiratory disorders two (4%). Spontaneous ventilation test with T-piece was performed in 49 (98%) patients and CPAP/PS in one (2%). Success at removal was reported in 44 (88%) patients. Measurement of diaphragmatic excursion prior to extubation, AUC of 0.8 (p = 0.009), cut-off point to predict successful extubation was 1.09, sensitivity of 97.7%, specificity of 83.3%; TPIA, AUC 0.79, cut-off point 0.81 seconds, p = 0.002, sensitivity of 79.5% and specificity 83.3%; NIF, AUC 0.48, cut-off point -23.5, p = 0.9, sensitivity 27.3%, specificity 33.3; Tobin/Yang index, AUC of 0.32, cut-off point 79, p = 0.2, sensitivity 18%, specificity 66.7%. Correlation coefficient of admission diaphragmatic excursion of 0.23, p= 0.1, diaphragmatic excursion at 48 hours of 0.81, p = 0.001, TPIA of 0.9, p = 0.001. Conclusion: both diaphragmatic excursion and the time to reach the peak inspiratory amplitude of the diaphragm, measured by ultrasound, present adequate sensitivity and specificity to predict successful extubation in the critically ill patient compared to negative inspiratory force.

REFERENCES

1. Carrillo ER, Perez CAA, Pena PCA. Evaluación ultrasonográfica de la función diafragmática mediante doble abordaje en el paciente grave. Rev Asoc Mex Med Crít Ter. 2016;30(4):242-245.

2. Zhou P, Zhang Z, Hong Y, et al. The predictive value of serial changes in diaphragm function during the spontaneous breathing trial for weaning outcome: a study protocol. BMJ Open. 2017;7(6):e015043.

3. Rittayamai N, Hemvimon S, Chierakul N. The evolution of diaphragm activity and function determined by ultrasound during spontaneous breathing trials. J Crit Care. 2019;51:133-138.

4. Qian Z, Yang M, Li L, Chen Y. Ultrasound assessment of diaphragmatic dysfunction as a predictor of weaning outcome from mechanical ventilation: a systematic review and meta-analysis. BMJ Open. 2018;8(9):e021189.

5. Theerawit P, Eksombatchai D, Sutherasan Y, Suwatanapongched T, Kiatboonsri C, Kiatboonsri S. Diaphragmatic parameters by ultrasonography for predicting weaning outcomes. BMC Pulm Med. 2018;18(1):175.

6. Flevari A, Lignos M, Konstantonis D, Armaganidis A. Diaphragmatic ultrasonography as an adjunct predictor tool of weaning success in patients with difficult and prolonged weaning. Minerva Anestesiol. 2016;82(11):1149-1157.

7. Dres M, Goligher EC, Heunks LMA, Brochard LJ. Critical illness-associated diaphragm weakness. Intensive Care Med. 2017;43(10):1441-1452.

8. Llamas-Álvarez AM, Tenza-Lozano EM, Latour-Pérez J. Diaphragm and lung ultrasound to predict weaning outcome: systematic review and meta-analysis. Chest. 2017152(6):1140-1150.

9. Vivier E, Muller M, Putegnat JB, et al. Inability of diaphragm ultrasound to predict extubation failure: a multicenter study. Chest. 2019;155(6):1131-1139.

10. Khan MT, Munawar K, Hussain SW, et al. Comparing ultrasound-based diaphragmatic excursion with rapid shallow breathing index as a weaning predictor. Cureus. 2018;10(12):e3710.

11. Llamas-Álvarez AM, Tenza-Lozano EM, Latour-Pérez J. Diaphragm and lung ultrasound to predict weaning outcome: systematic review and meta-analysis. Chest. 2017;152(6):1140-1150.

12. McCool FD, Tzelepis GE. Dysfunction of the diaphragm. N Engl J Med. 2012;366(10):932-42.

13. Dres M, Goligher EC, Heunks LMA, Brochard LJ. Critical illness-associated diaphragm weakness. Intensive Care Med. 2017;43(10):1441-1452.

14. Li C, Li X, Han H, Cui H, Wang G, Wang Z. Diaphragmatic ultrasonography for predicting ventilator weaning: a meta-analysis. Medicine (Baltimore). 2018;97(22):e10968.

15. DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax. 2014;69(5):423-427.

16. Dot I, Pérez-Teran P, Samper MA, Masclans JR. Diaphragm dysfunction in mechanically ventilated patients. Arch Bronconeumol. 2017;53(3):150-156.

17. Carrillo RE, Galván TY. Evaluación ultrasonográfica del diafragma en el enfermo grave. Rev. Asoc Mex Med Crit y Ter Int. 2014; 28(3):187-194.

18. Mariani LF, Bedel J, Gros A, et al. Ultrasonography for screening and follow-up of diaphragmatic dysfunction in the ICU: a pilot study. J Intensive Care Med. 2016;31(5):338-343.

19. Hernández-López GD. Retiro de la ventilación mecánica. Med Crít. 2017;31(4):238-245.

20. Varón-Vega F, Hernández Á, López M, et al. Usefulness of diaphragmatic ultrasound in predicting extubation success. Med Intensiva (Engl Ed). 2021;45(4):226-233.

21. Whebell S, Sane S, Naidu S, White H. Use of ultrasound to determine changes in diaphragm mechanics during a spontaneous breathing trial. J Intensive Care Med. 2021;36(9):1044-1052.