Usefulness of Combined Bedside Lung Ultrasound and Echocardiography to Assess Weaning Failure From Mechanical Ventilation

2013 ◽  
Vol 41 (8) ◽  
pp. e182-e185 ◽  
Author(s):  
Silvia Mongodi ◽  
Gabriele Via ◽  
Belaïd Bouhemad ◽  
Enrico Storti ◽  
Francesco Mojoli ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Ultrasound ◽  
Weaning Failure

scholarly journals THE IDEAL PROFILE (INCREASE IN B-LINES/DELTA B-LINES) ON LUNG ULTRASOUND FOR DIAGNOSING WEANING INDUCED PULMONARY EDEMA IN VENTILATED PATIENTS

2022 ◽  
Vol 71 (6) ◽  
pp. 2220-23
Author(s):  
Ghulam Rasheed ◽  
Zahid Siddique Shad ◽  
Tooba Mehreen ◽  
Nusrat Kharadi ◽  
Moazma Ramzan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Pulmonary Edema ◽  
Spontaneous Breathing ◽  
Lung Ultrasound ◽  
Weaning Failure ◽  
Before And After ◽  
Spontaneous Breathing Trials ◽  
B Lines ◽  
Ventilated Patients ◽  
The Ideal

Objective: To ascertain the ideal number of B-lines on lung ultrasound for the diagnosis of weaning induced pulmonary edema in ventilated patients. Study Design: Prospective observational study. Place and Duration of Study: Department of Medicine, Shifa International Hospital, Islamabad, from Jan to Aug 2020. Methodology: All the patients over the age of 18 years who were on mechanical ventilation in a medical intensive care unit were included in the study. The patients were given spontaneous breathing trials as a protocol for weaning from mechanical ventilation. Lung ultrasound was performed on 4 points of anterior chest wall before and after spontaneous breathing trials. Before and after spontaneous breathing trials counting of B lines was done on ultrasound of lung and comparison of increase in B lines (Delta-B-lines) was done with reference diagnosis of weaning induced pulmonary edema diagnosed by intensivist who was blinded to the results of lung ultrasound. Results: The study included 42 patients including 23 (54.8%) men and 19 (45.2%) women. 14 cases failed spontaneous breathing trials. Seven cases (16.7%) had weaning induced pulmonary edema. Delta-B-lines ≥6 diagnosed weaning induced pulmonary edema with 100% accuracy. Out of the remaining seven patients with weaning failure but without weaning induced pulmonary edema, 6 (28.6%) had Delta-B-lines ≥6. The ultrasound lung technique had a 100% sensitivity profile to detect weaning induced pulmonary edema and a specificity of 77.78%. Conclusion: The study indicates that Delta-B-lines ≥6 diagnosed the weaning induced pulmonary edema with the best accuracy.

scholarly journals Lung ultrasound to predict mechanical ventilation weaning failure

2015 ◽  
Vol 3 (S1) ◽  
Author(s):  
LY Delgado Ayala ◽  
O Torres ◽  
A Sanchez-Calzada ◽  
JL Navarro ◽  
A Torres ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Ultrasound ◽  
Weaning Failure ◽  
Ventilation Weaning ◽  
Mechanical Ventilation Weaning

scholarly journals Lung ultrasound findings predict weaning failure from mechanical ventilation

Critical Care ◽  
2014 ◽  
Vol 18 (Suppl 1) ◽  
pp. P298
Author(s):  
AC Pecanha Antonio ◽  
P Souza Castro ◽  
LF Schulz ◽  
J Maccari ◽  
R Oliveira ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Ultrasound ◽  
Weaning Failure ◽  
Ultrasound Findings

scholarly journals Noninvasive mechanical ventilation (NIMV) in weaning failure: could be an alternative approach?

Critical Care ◽  
10.1186/cc402 ◽  
1999 ◽  
Vol 3 (Suppl 1) ◽  
pp. P027
Author(s):  
A Esquinas ◽  
D González ◽  
A Carrillo ◽  
M Del Baño ◽  
M Rodríguez ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Noninvasive Mechanical Ventilation ◽  
Alternative Approach ◽  
Weaning Failure

scholarly journals Product of driving pressure and respiratory rate for predicting weaning outcomes

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110100
Author(s):  
Ju Gong ◽  
Bibo Zhang ◽  
Xiaowen Huang ◽  
Bin Li ◽  
Jian Huang
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Rate ◽  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Plateau Pressure ◽  
Driving Pressure ◽  
Failure Group ◽  
Rapid Shallow Breathing Index ◽  
Weaning Failure ◽  
Shallow Breathing

Objective Clinicians cannot precisely determine the time for withdrawal of ventilation. We aimed to evaluate the performance of driving pressure (DP)×respiratory rate (RR) to predict the outcome of weaning. Methods Plateau pressure (Pplat) and total positive end-expiratory pressure (PEEPtot) were measured during mechanical ventilation with brief deep sedation and on volume-controlled mechanical ventilation with a tidal volume of 6 mL/kg and a PEEP of 0 cmH2O. Pplat and PEEPtot were measured by patients holding their breath for 2 s after inhalation and exhalation, respectively. DP was determined as Pplat minus PEEPtot. The rapid shallow breathing index was measured from the ventilator. The highest RR was recorded within 3 minutes during a spontaneous breathing trial. Patients who tolerated a spontaneous breathing trial for 1 hour were extubated. Results Among the 105 patients studied, 44 failed weaning. During ventilation withdrawal, DP×RR was 136.7±35.2 cmH2O breaths/minute in the success group and 230.2±52.2 cmH2O breaths/minute in the failure group. A DP×RR index >170.8 cmH2O breaths/minute had a sensitivity of 93.2% and specificity of 88.5% to predict failure of weaning. Conclusions Measurement of DP×RR during withdrawal of ventilation may help predict the weaning outcome. A high DP×RR increases the likelihood of weaning failure. Statement: This manuscript was previously posted as a preprint on Research Square with the following link: https://www.researchsquare.com/article/rs-15065/v3 and DOI: 10.21203/rs.2.24506/v3

Lung Ultrasound to Monitor Disease Severity and Aid Prognostication in COVID-19 Pneumonia: A Retrospective Analysis of Serial Lung Ultrasound Assessments

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 109-116
Author(s):  
Matthew Llewelyn Gibbins ◽  
Quentin Otto ◽  
Paul Adrian Clarke ◽  
Stefan Gurney
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Analysis ◽  
Disease Severity ◽  
Scoring System ◽  
Lung Ultrasound ◽  
Weaning From Mechanical Ventilation ◽  
Icu Discharge ◽  
Successful Weaning ◽  
Ultrasound Assessment ◽  
Disease Free

Background: The aim of this retrospective analysis was to assess if serial lung ultrasound assessments in patients with COVID-19 pneumonia, including a novel simplified scoring system, correlate with PaO2:FiO2 ratio, as a marker of disease severity, and patient outcomes. Methods: Patients treated for COVID-19 pneumonia in a tertiary intensive care unit who had a lung ultrasound assessment were included. Standardised assessments of anterior and lateral lung regions were prospectively recorded. A validated lung ultrasound score-of-aeration and a simplified scoring system based on the number of disease-free lung regions were correlated with: PaO2:FiO2 ratio,  successful weaning from mechanical ventilation, and status (alive or dead) at discharge.  MedCalc© statistical software was used for statistical analysis. Results: 28 patients (109 assessments) were included. Correlation was seen between score-of-aeration and PaO2:FiO2 ratio (r = -0.61, p<0.0001) and between the simplified scoring system and PaO2:FiO2 ratio (r = 0.52 p<0.0001). Achieving a score-of-aeration of ≤9/24 or ≥2 disease-free regions was associated with successful weaning from mechanical ventilation and survival to ICU discharge (accuracy of 94% and 97% respectively). Conclusion: Retrospective analysis from this small cohort of patients demonstrates that scores-of-aeration and a simplified scoring system based on the number of disease-free antero-lateral regions from serial LUS assessments correlate with PaO2:FiO2 ratio as a marker of disease severity in patients with COVID-19 pneumonia. In addition, lung ultrasound may help identify patients who will have favourable outcomes. 

scholarly journals Do Serial Lung Ultrasound Scores Predict Prolonged Mechanical Ventilation in Patients With Severe COVID-19? A Single-centre Retrospective Cohort Study

2021 ◽  
Author(s):  
Hayato Taniguchi ◽  
Aimi Ohya ◽  
Hidehiro Yamagata ◽  
Masayuki Iwashita ◽  
Takeru Abe ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Ultrasound ◽  
Prolonged Mechanical Ventilation ◽  
X Rays ◽  
C Reactive Protein ◽  
Time Points ◽  
Reactive Protein ◽  
Bedside Test ◽  
Successful Extubation

Abstract Background: Some patients with severe coronavirus disease (COVID-19) who present with fibrosis on computed tomography (CT) require prolonged mechanical ventilation (PMV). Lung ultrasound (LUS), a rapid, bedside test, has been reported to have findings consistent with those of CT. Thus, this study aimed to assess whether serial LUS scores could predict PMV or successful extubation in severe COVID-19 patients.Methods: LUS was performed for 20 consecutive severe COVID-19 patients at three time points: admission (day 1), after 48 h (day 3), and seventh-day follow-up (day 7). We compared the LUS score with the results of chest X-rays and laboratory tests at three time points. Moreover, we assessed LUS score to determine the inter-rater reliability (IRR) of the results among examiners.Results: While there were no significant differences in mortality in each PMV and successful extubation groups, there were significant differences in LUS scores on day 3 and day 7; XP score on day 7; and P/F ratio on day 7 in the PMV group (p<0.05). There were significant differences in LUS scores on days 3 and 7, C-reactive protein (CRP) levels on day 7, and P/F ratio on day 7 in the successful extubation group (p<0.05). The areas under the curves (AUCs) of LUS score on days 3 and 7, XP score on day 7, and P/F ratio were 0.88, 0.98, 0.77, and 0.80, respectively in the PMV group; and the AUCs of LUS score on days 3 and 7, CRP levels on day 7, and P/F ratio 0.79, 0.90, 0.82, and 0.79, respectively, in the successful extubation group. Variations in serial LUS scores exhibited significant differences between the groups. The serial LUS score on day 7 was higher than that on day 1 in the PMV group but lower in the successful extubation group (p<0.05). However, there was slight IRR agreement in the LUS score changes on days 1 to 7 (κ= 0.15 [95% CI: 0-0.31]). Conclusions: The serial LUS score of severe COVID-19 patients could predicted PMV and successful extubation. To overcome IRR disagreement, the automatic ultrasound judgement, such as deep learning, would be needed.

scholarly journals Respiratory Muscle Effort during Expiration in Successful and Failed Weaning from Mechanical Ventilation

2018 ◽  
Vol 129 (3) ◽  
pp. 490-501 ◽  
Author(s):  
Jonne Doorduin ◽  
Lisanne H. Roesthuis ◽  
Diana Jansen ◽  
Johannes G. van der Hoeven ◽  
Hieronymus W. H. van Hees ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Electrical Activity ◽  
Muscle Activity ◽  
Respiratory Muscle ◽  
Weaning From Mechanical Ventilation ◽  
Expiratory Muscle ◽  
Diaphragm Electrical Activity ◽  
Gastric Pressure ◽  
Weaning Failure ◽  
Expiratory Muscles

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Respiratory muscle weakness in critically ill patients is associated with difficulty in weaning from mechanical ventilation. Previous studies have mainly focused on inspiratory muscle activity during weaning; expiratory muscle activity is less well understood. The current study describes expiratory muscle activity during weaning, including tonic diaphragm activity. The authors hypothesized that expiratory muscle effort is greater in patients who fail to wean compared to those who wean successfully. Methods Twenty adult patients receiving mechanical ventilation (more than 72 h) performed a spontaneous breathing trial. Tidal volume, transdiaphragmatic pressure, diaphragm electrical activity, and diaphragm neuromechanical efficiency were calculated on a breath-by-breath basis. Inspiratory (and expiratory) muscle efforts were calculated as the inspiratory esophageal (and expiratory gastric) pressure–time products, respectively. Results Nine patients failed weaning. The contribution of the expiratory muscles to total respiratory muscle effort increased in the “failure” group from 13 ± 9% at onset to 24 ± 10% at the end of the breathing trial (P = 0.047); there was no increase in the “success” group. Diaphragm electrical activity (expressed as the percentage of inspiratory peak) was low at end expiration (failure, 3 ± 2%; success, 4 ± 6%) and equal between groups during the entire expiratory phase (P = 0.407). Diaphragm neuromechanical efficiency was lower in the failure versus success groups (0.38 ± 0.16 vs. 0.71 ± 0.36 cm H2O/μV; P = 0.054). Conclusions Weaning failure (vs. success) is associated with increased effort of the expiratory muscles and impaired neuromechanical efficiency of the diaphragm but no difference in tonic activity of the diaphragm.

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