Chinese Journal of Respiratory and Critical Care Medicine
Supervisor：Ministry of Education of the People's Republic of ChinaSponsor：West China Medical Center & West China Hospital, Sichuan University Editor-in-chief：LIN Jiangtao / LIU Chuntao Publishing period：
Monthly
ISSN：1671-6205CN：51-1631/R
Latest ArticlesFeasibility of inferior vena cava variability combined with diaphragmatic-rapid shallow reathing index in predicting weaning outcomes of elderly mechanically ventilated patients
1. Department of Cardio-Thoracic Surgery, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121001, P.R. China;
2. Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121001, P.R. China;
3. Department of Intensive Care Unit, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121001, P.R. China;
4. Nephrology department, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121001, P.R. China;
Objective To investigate the predictive value of inferior vena cava variability (ΔDIVC) combined with the diaphragmatic-rapid shallow breathing index (D-RSBI) for weaning outcomes in elderly mechanically ventilated (MV) patients. Methods Clinical data from 298 elderly MV patients (age≥60 years) admitted to the ICU of the First Affiliated Hospital of Jinzhou Medical University between January and December 2023 were retrospectively analyzed. According to weaning outcomes (success: extubation without reintubation within 48 hours; failure: reintubation within 48 hours), patients were divided into a success group (n=211) and a failure group (n=87). Bedside ultrasound was used to measure ΔDIVC and D-RSBI. Receiver operating characteristic (ROC) curve analysis and Pearson correlation were employed to evaluate their predictive efficacy. Results The success group showed significantly higher ΔDIVC (25.24±4.48% vs. 20.18±3.24%, P<0.001) and lower D-RSBI (1.61±0.22 vs. 2.20±0.33, P<0.001) than the failure group. For predicting weaning success, ΔDIVC yielded an AUC of 0.813 (sensitivity 78.20%, specificity 65.52%, cut-off 21.5%). For predicting weaning failure, D-RSBI yielded an AUC of 0.918 (sensitivity 89.10%, specificity 89.66%, cut-off 1.85 counts·min-1·mm-1). The combined model achieved an AUC of 0.954 (95%CI 0.930~0.978), significantly outperforming either parameter alone (P<0.05). ΔDIVC and D-RSBI were negatively correlated (r=–0.351, P<0.001). Conclusion The combination of ΔDIVC and D-RSBI significantly improves the accuracy of predicting weaning outcomes in elderly MV patients, providing a reliable basis for individualized clinical weaning strategies.
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Long E, Oakley E, Duke T, et al. Does respiratory variation in inferior vena cava diameter predict fluid responsiveness: a systematic review and meta-analysis. Shock, 2017, 47(5): 550-559.
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Lamia B, Maizel J, Ochagavia A, et al. Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation. Critical Care Medicine, 2009, 37(5): 1696-1701.
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Roche-Campo F, Bedet A, Vivier E, et al. Cardiac function during weaning failure: the role of diastolic dysfunction. Ann Intensive Care, 2018, 8(1): 2.
Dres M, Dube BP, Mayaux J, et al. Coexistence and Impact of Limb Muscle and Diaphragm Weakness at Time of Liberation From Mechanical Ventilation in Medical ICU Patients. Am J Respir Crit Care Med, 2016, 195(1): 57-66.
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Goligher 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.
1. Wilson NJ, Boniface K, Chan JR, et al. Development, cytokine profile and function of human interleukin 17-producing helper T cells. Nat Immunol, 2007, 8(9): 950-957.
2. Alam MJ, Roy S, Iktidar MA, et al. Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index. Acute Crit Care, 2022, 37(1): 94-100.
5. Mahmood SS, Pinsky MR. Heart-lung interactions during mechanical ventilation: the basics. Annals of Translational Medicine, 2018, 6(18): 349.
6. Lara TM, Hajjar LA, de Almeida JP, et al. High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery. Clinics (Sao Paulo), 2016, 68(1): 33-38.
7. Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J, 2007, 29(5): 1033-1056.
8. Pinsky MR. Cardiopulmonary Interactions: physiologic Basis and Clinical Applications. Ann Am Thorac Soc, 2018, 15(Suppl 1): S45-S48.
9. Long E, Oakley E, Duke T, et al. Does respiratory variation in inferior vena cava diameter predict fluid responsiveness: a systematic review and meta-analysis. Shock, 2017, 47(5): 550-559.
10. Lamia B, Maizel J, Ochagavia A, et al. Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation. Critical Care Medicine, 2009, 37(5): 1696-1701.
11. Roche-Campo F, Bedet A, Vivier E, et al. Cardiac function during weaning failure: the role of diastolic dysfunction. Ann Intensive Care, 2018, 8(1): 2.
13. Dres M, Dube BP, Mayaux J, et al. Coexistence and Impact of Limb Muscle and Diaphragm Weakness at Time of Liberation From Mechanical Ventilation in Medical ICU Patients. Am J Respir Crit Care Med, 2016, 195(1): 57-66.
14. Goligher 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.
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Citation：GUO Chuang, CHU Yun, ZHANG Fengxiang, CUI Xiangfei. Feasibility of inferior vena cava variability combined with diaphragmatic-rapid shallow reathing index in predicting weaning outcomes of elderly mechanically ventilated patients. Chinese Journal of Respiratory and Critical Care Medicine, 2026. doi: 10.7507/1671-6205.202506092
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