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.	竇志敏, 李紅, 朱磊, 等. 膈肌淺快呼吸指數對機械通氣慢性阻塞性肺疾病患者撤機的預測價值. 中國呼吸與危重監護雜志, 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.	楊旻, 李惠, 尹璐, 等. 床旁肺部超聲在重癥患者機械通氣脫機評估中的應用價值. 中國急救醫學, 2017, 37(11): 1000-1004.
7.	劉英芹, 盧廣民, 劉耿熙, 等. 膈肌活動度超聲檢測、血清 NT-proBNP 及被動抬腿試驗容量反應性對機械通氣患者困難撤機的預測價值. 山東醫學高等專科學校學報, 2016, 38(6): 417-420.
8.	胡仕靜, 周樹生, 吳丹, 等. 膈肌超聲預測機械通氣撤機結果的價值. 安徽醫科大學學報, 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.	孫強, 山峰, 董海, 等. 超聲膈肌增厚率對重癥肌無力危象機械通氣患者撤機成功的預測價值. 中華危重病急救醫學, 2017, 9(7): 619-623.
15.	張海翔, 龔仕金, 宋佳, 等. 膈肌超聲指標對機械通氣患者撤機結果的預測價值研究. 浙江醫學, 2018, 9(5): 919-923.
16.	宋潔瓊, 鐘鳴. 膈肌超聲在危重癥中的臨床應用. 中華診斷學電子雜志, 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.	陸志華, 徐秋萍, 袁月華, 等. 膈肌增厚分數指導慢性阻塞性肺疾病機械通氣患者撤機的臨床研究. 中華急診醫學雜志, 2016, 25(4): 491-494.
19.	龔仕金, 宋佳, 張海翔. 重癥超聲: 脫機過程中一種有用的評估工具. 浙江醫學, 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.	劉岷, 駢林萍. 超聲評價膈肌活動度與慢性阻塞性肺疾病患者生活質量及運動能力的相關性研究. 中國呼吸與危重監護雜志, 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. 竇志敏, 李紅, 朱磊, 等. 膈肌淺快呼吸指數對機械通氣慢性阻塞性肺疾病患者撤機的預測價值. 中國呼吸與危重監護雜志, 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. 楊旻, 李惠, 尹璐, 等. 床旁肺部超聲在重癥患者機械通氣脫機評估中的應用價值. 中國急救醫學, 2017, 37(11): 1000-1004.
7. 劉英芹, 盧廣民, 劉耿熙, 等. 膈肌活動度超聲檢測、血清 NT-proBNP 及被動抬腿試驗容量反應性對機械通氣患者困難撤機的預測價值. 山東醫學高等專科學校學報, 2016, 38(6): 417-420.
8. 胡仕靜, 周樹生, 吳丹, 等. 膈肌超聲預測機械通氣撤機結果的價值. 安徽醫科大學學報, 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. 孫強, 山峰, 董海, 等. 超聲膈肌增厚率對重癥肌無力危象機械通氣患者撤機成功的預測價值. 中華危重病急救醫學, 2017, 9(7): 619-623.
15. 張海翔, 龔仕金, 宋佳, 等. 膈肌超聲指標對機械通氣患者撤機結果的預測價值研究. 浙江醫學, 2018, 9(5): 919-923.
16. 宋潔瓊, 鐘鳴. 膈肌超聲在危重癥中的臨床應用. 中華診斷學電子雜志, 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. 陸志華, 徐秋萍, 袁月華, 等. 膈肌增厚分數指導慢性阻塞性肺疾病機械通氣患者撤機的臨床研究. 中華急診醫學雜志, 2016, 25(4): 491-494.
19. 龔仕金, 宋佳, 張海翔. 重癥超聲: 脫機過程中一種有用的評估工具. 浙江醫學, 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. 劉岷, 駢林萍. 超聲評價膈肌活動度與慢性阻塞性肺疾病患者生活質量及運動能力的相關性研究. 中國呼吸與危重監護雜志, 2018, 17(6): 548-551.

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The predictive value of diaphragm ultrasound for weaning from mechanical ventilation

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