The predictive value of diaphragm ultrasound for weaning from mechanical ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 LIN Ning ¹ , HUANG Qiuxia ² , ZHANG Huizhen ² , CHEN Mengqi ¹ , TANG Li ¹ , LU Fengfeng ³

1. Department of Ultrasound, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian 350001, P. R. China;
2. Department of Ultrasound, Fujian Provincial Jinshan Hospital, Fuzhou, Fujian 350028, P. R. China;
3. Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, Fujian 350001, P. R. China;

Corresponding author：

LIN Ning, Email: linningxin@163.com

Keywords：

Mechanical ventilation; Weaning; Ultrasonography; Diaphragm; Predicting value

DOI：

10.7507/1671-6205.201808027

Video：

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Objective To evaluate the predictive value of the diaphragm ultrasound for weaning from mechanical ventilation.Methods The patients who received mechanical ventilation in Fujian Provincial Hospital between February 2016 to December 2017 and met the criteria for a T-tube spontaneous breathing trial were included in the study. Then right diaphragmatic displacement (DD) and diaphragmatic thickening fraction (DTF) were evaluated using M-mode ultrasonography as well as the rapid shallow breathing index (RSBI, the ratio of respiratory rate to tidal volume). A new index was named as the diaphragmatic-RSBI (D-RSBI, the ratio of respiratory rate to DD). The patients were classified into a success group or a failure group according to the weaning outcomes. The receiver operating characteristic (ROC) curves were calculated to evaluate the predictive performance of each index.Results Fifty-nine patients were weaned successfully and failure of weaning was found in 29 patients. There were no statistically significant differences in pre-weaning parameters including age, sex, systolic blood pressure, diastolic blood pressure, blood lipid index (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride), or fast blood glucose between the weaning success group and the weaning failure group (P>0.05), but there were statistically significant differences in body mass index and acute physiology and chronic health condition Ⅱ score between two groups (P<0.05). DD [(13.44±3.23)mm vs. (10.28±2.82)mm, DTF [(32.43±12.35)% vs. (27.64±5.77)%, P<0.05] and D-RSBI [(1.49±0.47) breaths·min^–1·mm^–1 vs. (2.55±0.87) breaths·min^–1·mm^–1, P<0.05] differed significantly between the weaning success group and the weaning failure group. A cutoff of DTF≥27.9% yielded a sensitivity of 98.3%, a specificity of 62.1%, and an area under the ROC curve (AUC) of 0.873. A cutoff of D-RSBI≤1.73 breaths·min^–1·mm^–1 yielded a sensitivity of 76.3%, a specificity of 93.1%, and an AUC of 0.887. By comparison, when RSBI was ≤50.9 breaths·min^–1·mm^–1, there was a sensitivity of 91.5%, a specificity of 86.2%, and an AUC of 0.927. There was no statistically significant difference in AUC between D-RSBI and RSBI (P>0.05).Conclusions Diaphragm ultrasound is feasible to predict the outcome of weaning. DTF and D-RSBI are as same accurate as the traditional RSBI in predicting the weaning outcome, but more objective and suitable for clinical application.

Citation： LIN Ning, HUANG Qiuxia, ZHANG Huizhen, CHEN Mengqi, TANG Li, LU Fengfeng. The predictive value of diaphragm ultrasound for weaning from mechanical ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(4): 339-343. doi: 10.7507/1671-6205.201808027 Copy

1.	Zein H, Baratloo A, Negida A, et al. Ventilator weaning and spontaneous breathing trials: an educational review. Emergency (Tehran), 2016, 4(2): 65-71.
2.	Demoule A, Jung B, Prodanovic H, et al. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-a prospective study. Am J Respir Crit Care Med, 2013, 188(2): 213-219.
3.	Harper CJ, Shahgholi L, Cieslak K, et al. Variability in diaphragm motion during normal breathing, assessed with B-mode ultrasound. J Orthop Sports Phys Ther, 2013, 43(12): 927-931.
4.	窦志敏, 李红, 朱磊, 等. 膈肌浅快呼吸指数对机械通气慢性阻塞性肺疾病患者撤机的预测价值. 中国呼吸与危重监护杂志, 2017, 16(2): 124-127.
5.	Doorduin J, van Hees HW, vander Hoeven JG, et al. Monitoring of the respiratory muscles in the critically ill. Am J Respir Crit Care Med, 2013, 187(1): 20-27.
6.	杨旻, 李惠, 尹璐, 等. 床旁肺部超声在重症患者机械通气脱机评估中的应用价值. 中国急救医学, 2017, 37(11): 1000-1004.
7.	刘英芹, 卢广民, 刘耿熙, 等. 膈肌活动度超声检测、血清 NT-proBNP 及被动抬腿试验容量反应性对机械通气患者困难撤机的预测价值. 山东医学高等专科学校学报, 2016, 38(6): 417-420.
8.	胡仕静, 周树生, 吴丹, 等. 膈肌超声预测机械通气撤机结果的价值. 安徽医科大学学报, 2016, 51(5): 673-677.
9.	Goligher EC, Laghi F, Detsky ME, et al. Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity. Intensive Care Med, 2015, 41(4): 642-649.
10.	Golisher EC, Fan E, Herridge MS, et al. Evolution of diaphragm thickness during mechanical ventilation. Impact of inspiratory effort. Am J Respir Crit Care Med, 2015, 192(9): 1080-1088.
11.	Schepens T, Verbrugghe W, Dams K, et al. The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study. Crit Care, 2015, 19: 422.
12.	Boon AJ, Sekiguchi H, Harper CJ, et al. Sensitivity and specificity of diagnostic ultrasound in the diagnosis of phrenic neuropathy. Neurology, 2014, 83(14): 1264-1270.
13.	Ferrari G, De Filippi G, Elia F, et al. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J, 2014, 6(1): 8.
14.	孙强, 山峰, 董海, 等. 超声膈肌增厚率对重症肌无力危象机械通气患者撤机成功的预测价值. 中华危重病急救医学, 2017, 9(7): 619-623.
15.	张海翔, 龚仕金, 宋佳, 等. 膈肌超声指标对机械通气患者撤机结果的预测价值研究. 浙江医学, 2018, 9(5): 919-923.
16.	宋洁琼, 钟鸣. 膈肌超声在危重症中的临床应用. 中华诊断学电子杂志, 2018, 6(2): 95-97.
17.	Zambon M, Greco M, Bocchino S, et al. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intensive Care Med, 2017, 43(1): 29-38.
18.	陆志华, 徐秋萍, 袁月华, 等. 膈肌增厚分数指导慢性阻塞性肺疾病机械通气患者撤机的临床研究. 中华急诊医学杂志, 2016, 25(4): 491-494.
19.	龚仕金, 宋佳, 张海翔. 重症超声: 脱机过程中一种有用的评估工具. 浙江医学, 2017, 39(3): 149-151.
20.	Farghaly S, Hasan AA. Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients. Aust Crit Care, 2017, 30(1): 37-43.
21.	Matamis D, Soilemezi E, Tsagourias M, et al. Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications. Intensive Care Med, 2013, 39(5): 801-810.
22.	刘岷, 骈林萍. 超声评价膈肌活动度与慢性阻塞性肺疾病患者生活质量及运动能力的相关性研究. 中国呼吸与危重监护杂志, 2018, 17(6): 548-551.

1. Zein H, Baratloo A, Negida A, et al. Ventilator weaning and spontaneous breathing trials: an educational review. Emergency (Tehran), 2016, 4(2): 65-71.
2. Demoule A, Jung B, Prodanovic H, et al. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-a prospective study. Am J Respir Crit Care Med, 2013, 188(2): 213-219.
3. Harper CJ, Shahgholi L, Cieslak K, et al. Variability in diaphragm motion during normal breathing, assessed with B-mode ultrasound. J Orthop Sports Phys Ther, 2013, 43(12): 927-931.
4. 窦志敏, 李红, 朱磊, 等. 膈肌浅快呼吸指数对机械通气慢性阻塞性肺疾病患者撤机的预测价值. 中国呼吸与危重监护杂志, 2017, 16(2): 124-127.
5. Doorduin J, van Hees HW, vander Hoeven JG, et al. Monitoring of the respiratory muscles in the critically ill. Am J Respir Crit Care Med, 2013, 187(1): 20-27.
6. 杨旻, 李惠, 尹璐, 等. 床旁肺部超声在重症患者机械通气脱机评估中的应用价值. 中国急救医学, 2017, 37(11): 1000-1004.
7. 刘英芹, 卢广民, 刘耿熙, 等. 膈肌活动度超声检测、血清 NT-proBNP 及被动抬腿试验容量反应性对机械通气患者困难撤机的预测价值. 山东医学高等专科学校学报, 2016, 38(6): 417-420.
8. 胡仕静, 周树生, 吴丹, 等. 膈肌超声预测机械通气撤机结果的价值. 安徽医科大学学报, 2016, 51(5): 673-677.
9. Goligher EC, Laghi F, Detsky ME, et al. Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity. Intensive Care Med, 2015, 41(4): 642-649.
10. Golisher EC, Fan E, Herridge MS, et al. Evolution of diaphragm thickness during mechanical ventilation. Impact of inspiratory effort. Am J Respir Crit Care Med, 2015, 192(9): 1080-1088.
11. Schepens T, Verbrugghe W, Dams K, et al. The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study. Crit Care, 2015, 19: 422.
12. Boon AJ, Sekiguchi H, Harper CJ, et al. Sensitivity and specificity of diagnostic ultrasound in the diagnosis of phrenic neuropathy. Neurology, 2014, 83(14): 1264-1270.
13. Ferrari G, De Filippi G, Elia F, et al. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J, 2014, 6(1): 8.
14. 孙强, 山峰, 董海, 等. 超声膈肌增厚率对重症肌无力危象机械通气患者撤机成功的预测价值. 中华危重病急救医学, 2017, 9(7): 619-623.
15. 张海翔, 龚仕金, 宋佳, 等. 膈肌超声指标对机械通气患者撤机结果的预测价值研究. 浙江医学, 2018, 9(5): 919-923.
16. 宋洁琼, 钟鸣. 膈肌超声在危重症中的临床应用. 中华诊断学电子杂志, 2018, 6(2): 95-97.
17. Zambon M, Greco M, Bocchino S, et al. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intensive Care Med, 2017, 43(1): 29-38.
18. 陆志华, 徐秋萍, 袁月华, 等. 膈肌增厚分数指导慢性阻塞性肺疾病机械通气患者撤机的临床研究. 中华急诊医学杂志, 2016, 25(4): 491-494.
19. 龚仕金, 宋佳, 张海翔. 重症超声: 脱机过程中一种有用的评估工具. 浙江医学, 2017, 39(3): 149-151.
20. Farghaly S, Hasan AA. Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients. Aust Crit Care, 2017, 30(1): 37-43.
21. Matamis D, Soilemezi E, Tsagourias M, et al. Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications. Intensive Care Med, 2013, 39(5): 801-810.
22. 刘岷, 骈林萍. 超声评价膈肌活动度与慢性阻塞性肺疾病患者生活质量及运动能力的相关性研究. 中国呼吸与危重监护杂志, 2018, 17(6): 548-551.

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