The predictive value of inferior vena cava ultrasound for mechanical weaning outcome_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 WANG Zeyu , WU Yunfu , CHEN Gang , LI Jia

Department of Emergency and Critical Care Medicine, Suzhou Municipal Hospital East District, Suzhou, Jiangsu 215001, P. R. China;

Corresponding author：

WANG Zeyu, Email: 250491667@qq.com

Keywords：

Respiratory failure; Ultrasound; Mechanical ventilation; Spontaneous breathing test; Weaning

DOI：

10.7507/1671-6205.201809035

Video：

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Objective To investigate whether inferior vena cava (IVC) ultrasound can improve the success rate of weaning in patients with respiratory failure by comparing the difference of success rate between ultrasound-guided weaning mode and spontaneous breathing test (SBT) weaning mode.Methods From November 2017 to May 2018, 31 respiratory failure patients underwent mechanical ventilation in intensive care unit were randomly divided into an ultrasonic guidance group (16 cases) and a control group (15 cases). All of them were offline after meeting the offline indications. The routine group was assessed by SBT for offline procedures. The diameter and variation rate of inferior vena cava were measured at SBT. IVC diameter >2.0 cm and variation rate < 50% were given intravenous diuretics. After the IVC diameter reached the standard again, the catheter was taken off the machine after passing SBT. The patients of both groups were considered as successfully weaned when they were able to tolerate at least 48 consecutive hours of spontaneous breathing. The following data were recorded at weaning, ie. Acute Physiological and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, arterial blood gas analysis, plasma albumin, serum electrolyte sodium, potassium, 7-day and 14-day weaning success rate.Results There were no significant differences in APACHEⅡ score, plasma albumin level, arterial oxygen partial pressure, carbon dioxide partial pressure, pH, blood sodium level or blood potassium level between the two groups at the beginning of weaning (all P>0.05), and the 2-day weaning success rate was higher in the ultrasound group than that in the control group (95% vs. 73%, P=0.039); the 7-day weaning success rate was higher in the ultrasound group than that in the control group (87% vs. 66%, P=0.043). No significant difference was found in the 14-day weaning success rate (68% in the ultrasound group vs. 53% in the control group, P=0.446).Conclusion Ultrasound can improve the success rate of weaning in patients with respiratory failure.

Citation： WANG Zeyu, WU Yunfu, CHEN Gang, LI Jia. The predictive value of inferior vena cava ultrasound for mechanical weaning outcome. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(4): 344-347. doi: 10.7507/1671-6205.201809035 Copy

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3.	Pinheiro BDV. The difficult task of searching for tools that help predict mechanical ventilator weaning success. J Bras Pneumol, 2017, 43(4): 249-250.
4.	Tobin MJ, Laghi F, Jubran A. Ventilatory failure, ventilator support, and ventilator weaning. Compr Physiol, 2012, 2(4): 2871-2921.
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6.	Vieillard-Baron A, Prin S, Chergui K, et al. Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med, 2002, 166(10): 1310-1319.
7.	Noritomi DT, Vieira ML, Mohovic T, et al. Echocardiography for hemodynamic evaluation in the intensive care unit. Shock, 2010, 34(Suppl l): 59-62.
8.	Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr, 2010, 23(7): 685-713.
9.	张青, 刘大为, 陈焕, 等. 超声观测不同部位下腔静脉内径形变指数的研究初探. 中华内科杂志, 2015, 54(6): 491-495.
10.	Price S, Nicol E, Gibson DG, et al. Echocardiography in the critically ill: current and potential roles. Intensive Care Med, 2006, 32(1): 48-59.
11.	Gerstle J, Shahul S, Mahmood F. Echocardiographically derived parameters of fluid responsiveness. Int Anesthesiol Clin, 2010, 48(1): 37-44.
12.	Vieillard-Baron A, Caille V, Charron C, et al. Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med, 2008, 36(6): 1701-1706.
13.	Oropello J, Rahmanian M. Can chest sonography predict and facilitate successful ventilator weaning?. Crit Care Med, 2013, 41(8): 2065-2067.
14.	Caille V, Amiel JB, Charron C, et al. Echocardiography: a help in the weaning process. Crit Care, 2010, 14(3): R120.
15.	Salem R, Vallee F, Rusca M, et al. Hemodynamic monitoring by echocardiography in the ICU: the role of the new echo techniques. Curr Opin Crit Care, 2008, 14(5): 561-568.
16.	王小亭, 刘大为, 于凯江, 等. 中国重症超声专家共识. 中华内科杂志, 2016, 55(11): 900-912.
17.	Morris C, Bennett S, Bum S, et al. Echocardiography in the intensive care unit: current position, future directions. J Intensive Care Soc, 2010, 11(2): 90-97.

1. Zein H, Baratloo A, Negida A, et al. Ventilator weaning and spontaneous breathing trials; an educational review. Emerg (Tehran), 2016, 4(2): 65-71.
2. Hartmann SM, Zimmerman JJ. Standardization of ventilator weaning benefits both researchers and clinicians. Crit Care Med, 2017, 45(1): 139-140.
3. Pinheiro BDV. The difficult task of searching for tools that help predict mechanical ventilator weaning success. J Bras Pneumol, 2017, 43(4): 249-250.
4. Tobin MJ, Laghi F, Jubran A. Ventilatory failure, ventilator support, and ventilator weaning. Compr Physiol, 2012, 2(4): 2871-2921.
5. Branson RD. Modes to facilitate ventilator weaning. Respir Care, 2012, 57(10): 1635-1648.
6. Vieillard-Baron A, Prin S, Chergui K, et al. Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med, 2002, 166(10): 1310-1319.
7. Noritomi DT, Vieira ML, Mohovic T, et al. Echocardiography for hemodynamic evaluation in the intensive care unit. Shock, 2010, 34(Suppl l): 59-62.
8. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr, 2010, 23(7): 685-713.
9. 张青, 刘大为, 陈焕, 等. 超声观测不同部位下腔静脉内径形变指数的研究初探. 中华内科杂志, 2015, 54(6): 491-495.
10. Price S, Nicol E, Gibson DG, et al. Echocardiography in the critically ill: current and potential roles. Intensive Care Med, 2006, 32(1): 48-59.
11. Gerstle J, Shahul S, Mahmood F. Echocardiographically derived parameters of fluid responsiveness. Int Anesthesiol Clin, 2010, 48(1): 37-44.
12. Vieillard-Baron A, Caille V, Charron C, et al. Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med, 2008, 36(6): 1701-1706.
13. Oropello J, Rahmanian M. Can chest sonography predict and facilitate successful ventilator weaning?. Crit Care Med, 2013, 41(8): 2065-2067.
14. Caille V, Amiel JB, Charron C, et al. Echocardiography: a help in the weaning process. Crit Care, 2010, 14(3): R120.
15. Salem R, Vallee F, Rusca M, et al. Hemodynamic monitoring by echocardiography in the ICU: the role of the new echo techniques. Curr Opin Crit Care, 2008, 14(5): 561-568.
16. 王小亭, 刘大为, 于凯江, 等. 中国重症超声专家共识. 中华内科杂志, 2016, 55(11): 900-912.
17. Morris C, Bennett S, Bum S, et al. Echocardiography in the intensive care unit: current position, future directions. J Intensive Care Soc, 2010, 11(2): 90-97.

Chinese Journal of Respiratory and Critical Care Medicine

The predictive value of inferior vena cava ultrasound for mechanical weaning outcome

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