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2020, Number 2

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Med Crit 2020; 34 (2)

Diaphragmatic excursion as a predictor of success in the removal of mechanical ventilation in obese patient

Valerio MB, Mendoza PE, Mendoza RM

Language: Spanish
References: 22
Page: 133-137
PDF size: 188.71 Kb.


ABSTRACT

Introduction: Respiratory support is an indication of admission to Intensive Care Units (ICU). The release of invasive mechanical ventilation (VMI), represents up to 40% of the time in VMI; comorbidities such as obesity are more frequent in the ICU; there are recommendations on the release of the VMI (LVMI) in this group of patients, however, there are no adjusted predictors of success for the Mexican population.
Objective: To evaluate the diaphragmatic excursion (ED) as a predictor of success in the removal of IMV in obese patients (PO). Material and methods: A cross-sectional, prospective, comparative and analytical study was conducted in POs admitted to ICUs with IMV for more than 48 hours, demographic variables, surface respiration index (RSBI), ED were analyzed, the outcome was the success in LVMI.
Results: The distribution by gender was women 42% and men 58%; age: 41.3 ± 12.8 years; hospital stay: 9.6 ± 4.6 days; VMI time: 8.8 ± 4.8 days, l body mass index (BMI): 33.3 ± 2.7; represented in grade I: 76%, grade II: 2%, grade III: 22%, RSBI: 59 ± 9.4; ED: 1.55 ± 0.11. The area under the curve (ABC) for RSBI was 0.60 and ED 0.77. Additionally, the best cut-off point for success was: RSBI ‹ 44 with 100% sensitivity and specificity, and ED › 1.9 cm with 100% sensitivity and specificity.
Conclusion: The best predictor of success was the ED with respect to the RSBI, new cut-off points for RSBI and ED are proposed.


REFERENCES

  1. De Jong A, Chanques G, Jaber S. Mechanical ventilation in obese ICU patients: from intubation to extubation. Crit Care. 2017;21(1):63.

  2. Tafelski S, Yi H, Ismaeel F, Krannich A, Spies C, Nachtigall I. Obesity in critically ill patients is associated with increased need of mechanical ventilation but not with mortality. J Infect Public Health. 2016;9(5):577-585.

  3. Mogri M, Mador J. Mechanical ventilation of the obese patient. Critical Care Management of the Obese Patient. 2013.

  4. Wadhwa A, Singh PM, Sinha AC. Airway management in patients with morbid obesity. Int Anesthesiol Clin. 2013;51(3):26-40.

  5. Sengupta S, Chakravarty C, Rudra A. Evidence-based practice of weaning from ventilator: a review. ATOTW. 2018;(6):6.

  6. Chen L, Gilstrap D, Cox CE. Mechanical ventilator discontinuation process. Clin Chest Med. 2016;37(4):693-699.

  7. García-Arreola DAP, Alcántara-Morales MA. Obesidad: alteraciones fisiopatológicas y su repercusión anestésica. Rev Mex Anest. 2014;37(S1):198-206.

  8. Hernández-López GD, Cerón-Juárez R, Escobar-Ortiz D, Graciano-Gaytán L, Gorordo-Delsol LA, Merinos-Sánchez G, et al. Retiro de la ventilación mecánica. Rev Asoc Mex Med Crit y Ter Int. 2017;31(4):238-245.

  9. Imber DA, Pirrone M, Zhang C, Fisher DF, Kacmarek RM, Berra L. Respiratory management of perioperative obese patients. Respir Care. 2016;61(12):1681-1692.

  10. Lu Z, Xu Q, Yuan Y, Zhang G, Guo F, Ge H. Diaphragmatic dysfunction is characterized by increased duration of mechanical ventilation in subjects with prolonged weaning. Respir Care. 2016;61(10):1316-1322.

  11. Zambon M, Greco M, Bocchino S, Cabrini L, Beccaria PF, Zangrillo A. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intensive Care Med. 2017;43(1):29-38.

  12. 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.

  13. Ricoy J, Rodríguez-Núñez N, Álvarez-Dobaño JM, Toubes ME, Riveiro V, Valdés L. Diaphragmatic dysfunction. Pulmonology. 2019;25(4):223-235.

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

  15. Schetz M, De Jong A, Deane AM, Druml W, Hemelaar P, Pelosi P, et al. Obesity in the critically ill: a narrative review. Intensive Care Med. 2019;45(6):757-769.

  16. 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.

  17. Shashaty MG, Stapleton RD. Physiological and management implications of obesity in critical illness. Ann Am Thorac Soc. 2014;11(8):1286-1297.

  18. Epstein SK. Destete de la ventilación mecánica: pruebas de preparación [monografía en Internet]. UpToDate. 2017.

  19. Peñuelas O, Thille AW, Esteban A. Discontinuation of ventilatory support: new solutions to old dilemmas. Curr Opin Crit Care. 2015;21(1):74-81.

  20. Umbrello M, Formenti P, Longhi D, Galimberti A, Piva I, Pezzi A, et al. Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study. Crit Care. 2015;19:161.

  21. Montaño JA, Olvera GCI, Aguirre SJS, Camarena AG, Franco GJ. Pronóstico de la ventilación mecánica invasiva en el paciente obeso críticamente enfermo. Rev Asoc Mex Med Crit y Ter Int. 2018;32(5):277-284.

  22. Pérez-Calatayud AA, Carrillo-Esper R, Arch-Tirado E. Propuesta de evaluación cuantitativa en el protocolo ultrasonográfico para retiro de la ventilación mecánica invasiva (GMEMI score). Gac Med Mex. 2016;152(3):304-312.




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