The role of diaphragmatic ultrasound as a predictor of successful extubation from mechanical ventilation in respiratory intensive care unit

Abstract Background The diaphragm muscle whose dysfunction may be very common in patients undergoing mechanical ventilation (Ferrari G, De Filippi G, Elia F, Panero F, Volpicelli G, Aprà F. Crit Ultrasound J 6:8, 2014). Aim: To evaluate real-time ultrasound in the evaluation of diaphragmatic thickening, thickening fraction, and/or excursion to predict extubation outcomes. We aimed to compare these parameters with other traditional weaning measures is a fundamental. Results Out of 80 included patients, 20 (25%) have failed extubation. Diaphragmatic thickening (DT), thickening fraction (DTF), and/or excursion (DE) were significantly higher in the successful group compared to those who failed extubation (p < 0.05). Cutoff values of diaphragmatic measures associated with successful extubation (during tidal breathing) were ≥ 17 mm for DE; ≥ 2.1 cm for DT inspiration; ≥ 15.5 mm for DT expiration, functional residual capacity (FRC); and ≥ 32.82% for DTF %, giving 68%, 95%, 62%, and 90% sensitivity, respectively, and 65%, 100%, 100%, and 75% specificity, respectively. Cutoff values of diaphragmatic parameters associated with successful extubation (during deep breathing) were > 28.5 mm DT Insp, total lung capacity (TLC); >22.5mm DT Exp (RV); >37 DTF %; and > 31 mm DE, giving 100%, 73%, 97%, and 75% sensitivity and 65%, 75%, 100%, and 55% specificity, respectively. Rapid shallow breathing index (RSBI) had 47% sensitivity but 90% specificity. Conclusion Ultrasound evaluation of diaphragmatic parameters could be a good predictor of weaning in patients who passed the T-tube.

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Analysis of Rapid Shallow Breathing Index as a Predictor for Successful Extubation from Mechanical Ventilation

CHEST Journal ◽

10.1378/chest.126.4_meetingabstracts.756s-b ◽

2004 ◽

Vol 126 (4) ◽

pp. 756S

Author(s):

Nirav G. Shah ◽

Burton Lee ◽

Gene Colice

Keyword(s):

Mechanical Ventilation ◽

Rapid Shallow Breathing Index ◽

Shallow Breathing ◽

Rapid Shallow Breathing ◽

Successful Extubation

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Ultrasound-guided assessment of diaphragmatic thickness as an indicator of successful extubation in mechanically ventilated cancer patients

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v23i2.1066 ◽

2019 ◽

pp. 175-185

Author(s):

Ahmed M. Soliman ◽

Mohga A. Samy ◽

Ashraf M. Heikal ◽

Mohamed A. El Ramely ◽

Tamer A. Kotb

Keyword(s):

Mechanical Ventilation ◽

Blood Gases ◽

Arterial Blood Gases ◽

Ultrasound Guided ◽

Diaphragm Thickness ◽

Percent Change ◽

Rapid Shallow Breathing Index ◽

Arterial Blood ◽

Shallow Breathing ◽

Successful Extubation

Objective: The study aimed to assess diaphragmatic thickness measurement by B-mode ultrasound for prediction of extubation and proper timing of weaning from mechanical ventilation in cancer patients admitted to the intensive care unit after major surgery.Methodology: A prospective, longitudinal study conducted at Surgical ICU, National Cancer Institute, Cairo University, Cairo. Fifty patients were recruited during the immediate postoperative period after major elective cancer surgery who needed mechanical ventilation (MV). Patients were enrolled when judged to be eligible for a test of weaning from MV according to clinical and arterial blood gases (ABG) criteria. The patient was assessed for weaning according to rapid shallow breathing index (RSBI) and ultrasound guided measurements of diaphragmatic thickness (tdi) during inspiration and expiration. The percent change in tdi between end-expiration and end-inspiration (Δtdi%) was calculated. The primary outcome measure was diagnostic accuracy of tdi and Δtdi% to predict weaning compared to ABG analysis (the gold standard for weaning).Results: After 48 hours, 13 patients were weaned according to ABG criteria. Kappa value (agreement) between RSBI and ABG was 0.974. Kappa between both tdi and Δtdi% and the ABG criteria was 0.891. The values differed slightly in patients tested after 72 hours. Sensitivity of a cut off level of tdi of 2 mm was 84.6% and 83.3% after 48 and 72 hours of MV, respectively. Sensitivity of Δtdi% of 20% was clearly higher after 72 hours (95.8%). Using ROC curves, Δtdi% of > 29.5% was also more sensitive after 72 hours.Conclusion: Ultrasound estimation of diaphragm function is a promising tool to help clinicians to judge weaning readiness in patients on mechanical ventilation following major cancer surgery. Diaphragm thickness and its change between end-expiration and end-inspiration showed high degree of agreement with arterial blood gases for predicting weaning readiness.Abbreviations: RSBI: Rapid shallow breathing index, MV: mechanical ventilation, tdi: diaphragm thickness, Δtdi%: percent change in tdi between end-expiration and end-inspiration, PPV: positive predictive value, NPV: negative predictive value, kappa: measure of agreement, NCI: National Cancer Institute, VIDD: ventilator-induced diaphragmatic dysfunctionCitation: Soliman AM, Samy MA, Heikal AM, El Ramely MA, Kotb TA. Ultrasoundguidedassessment of diaphragmatic thickness as an indicator of successful extubation. Anaesth pain & intensive care 2019;23(2):178-185

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Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index

Acute and Critical Care ◽

10.4266/acc.2021.01354 ◽

2022 ◽

Author(s):

Mohammad Jhahidul Alam ◽

Simanta Roy ◽

Mohammad Azmain Iktidar ◽

Fahmida Khatun Padma ◽

Khairul Islam Nipun ◽

...

Keyword(s):

Mechanical Ventilation ◽

Rapid Shallow Breathing Index ◽

Shallow Breathing ◽

Rapid Shallow Breathing ◽

Successful Extubation

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A COMPARATIVE STUDY ON THE DIAPHRAGM MUSCLE THICKNESS AND RAPID SHALLOW BREATHING INDEX (RSBI) AS A PREDICTOR FOR SUCCESSFUL EXTUBATION AMONG CRITICALLY ILL ADULT PATIENTS

Respirology ◽

10.1111/resp.13419_97 ◽

2018 ◽

Vol 23 ◽

pp. 43-43

Keyword(s):

Comparative Study ◽

Critically Ill ◽

Muscle Thickness ◽

Adult Patients ◽

Diaphragm Muscle ◽

Rapid Shallow Breathing Index ◽

Shallow Breathing ◽

Rapid Shallow Breathing ◽

Successful Extubation

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Product of driving pressure and respiratory rate for predicting weaning outcomes

Journal of International Medical Research ◽

10.1177/03000605211010045 ◽

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

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Ventilator induced Diaphragmatic Dysfunction assessed by Ultrasonography and its impact on Weaning outcome

QJM ◽

10.1093/qjmed/hcaa039.066 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

H M A Fawzy ◽

M H M Hassan ◽

A A M Alkholy

Keyword(s):

Mechanical Ventilation ◽

Operating Characteristics ◽

Diaphragmatic Dysfunction ◽

Rapid Shallow Breathing Index ◽

Weaning Failure ◽

Significant Difference ◽

Shallow Breathing ◽

Ventilation Modes ◽

Weaning Outcome ◽

Rapid Shallow Breathing

Abstract Background Ventilator induced diaphragmatic dysfunction (VIDD), as a loss of diaphragmatic force generating capacity due to the use of mechanical ventilation. Difficulties in discontinuing ventilatory support are encountered in 20–25% of mechanically ventilated patients, with a staggering 40% of time spent in the intensive care unit being devoted to weaning. M-mode ultrasonography is now an accepted qualitative method of assessing diaphragmatic motion in normal and pathological conditions. In this study, we evaluated whether diaphragmatic excursion (DE) as measured by M-mode sonography can be a predictor of weaning and diagnosis of VIDD. Aim The aim of this study is to determine the presence of ventilator induced diaphragmatic dysfunction (VIDD) diagnosed by M-mode ultrasonography and its impact on weaning outcome. Methodology This study was conducted prospectively in critical care unit in Ain Shams Hospital, a university-affiliated, tertiary referral center in Cairo, Egypt. Study subjects included 78 patients between August 2017 to August 2018. who required mechanical ventilation ≥72hrs. who fulfilled the spontaneous breath trial (SBT) criteria, at the start of a 1-hr SBT, each hemidiaphragm was evaluated M-mode sonography with the patient in the supine position. Rapid shallow Breathing index (RSBI) was simultaneously calculated at the bedside. Ultrasonographic Diaphragmatic Dysfunction (DD) was diagnosed if an Diaphragmatic Excursion (DE) was <10 mm or negative, the latter indicating paradoxical diaphragmatic movement. Results Diaphragmatic Dysfunction (DD) among the eligible 78 patients was 48% (n = 37). DD group had longer weaning time [39,2 (26-56) hrs. vs. 22.3 (30-16) hrs. p = 0.001) in DD vs. NDD group respectively and total ventilation time [140 (130-150) hrs. vs. 130 (120–140) hrs. p > 0.05) in DD vs. NDD group respectively. Weaning failure was (45.8% vs. 30.8%, p=0.01) in DD vs. NDD group respectively. In NDD group Rt. DE, mean 25.4 ±4.1 mm. While Lt. side was 25.3±4.6 mm, 11.25mm and 22mm (45-15) respectively. In DD group Rt. DE, mean 7.6 ±2.02mm, IQR 2.4 mm and median 8.2mm (10-1.9). While Lt. side was 9.2±0.8mm, 4.3mm and 8.9mm (9.8-5.7) respectively. The area under the receiver operating characteristics curve (ROC) of ultrasonographic criteria in predicting weaning failure was near similar to that of rapid shallow breathing index. Hypercapenic acidosis in NDD group might protect them from VIDD Conclusions DD is present in a significant percentage 48% (nearly half) of our medical ICU patients on MV ≥ 72 hrs which largely account for weaning failure. DD was associated with a significant longer weaning time, and ICU stay, with no significant difference in 30 day mortality Recommendations DE by US measurements is a valuable tool and is recommended as an adjunctive weaning index to aid prediction of weaning outcome. Evaluating the role of spontaneous ventilation modes and advanced ventilation modes as PAV and NAVA effects on decreas ing VIDD versus controlled modes.

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