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

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

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

QJM ◽  
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.

scholarly journals How Mechanical Ventilation Measurement, Cutoff and Duration Affect Rapid Shallow Breathing Index Accuracy: A Randomized Trial

2017 ◽  
Vol 9 (4) ◽  
pp. 289-296 ◽  
Author(s):  
Elaine Cristina Goncalves ◽  
Alessandra Fabiane Lago ◽  
Elaine Caetano Silva ◽  
Marcelo Barros de Almeida ◽  
Anibal Basile-Filho ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Randomized Trial ◽  
Rapid Shallow Breathing Index ◽  
Shallow Breathing ◽  
Rapid Shallow Breathing

scholarly journals Acupressure Improves the Weaning Indices of Tidal Volumes and Rapid Shallow Breathing Index in Stable Coma Patients Receiving Mechanical Ventilation: Randomized Controlled Trial

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Suh-Hwa Maa ◽  
Chiu-Hua Wang ◽  
Kuang-Hung Hsu ◽  
Horng-Chyuan Lin ◽  
Brian Yee ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Standard Care ◽  
Controlled Trial ◽  
Treatment Session ◽  
Randomized Controlled ◽  
Rapid Shallow Breathing Index ◽  
Respiratory Parameters ◽  
Shallow Breathing ◽  
The One ◽  
Rapid Shallow Breathing

Background. Acupressure has been shown to improve respiratory parameters. We investigated the effects of acupressure on weaning indices in stable coma patients receiving mechanical ventilation.Methods. Patients were randomly allocated to one of three treatments: standard care with adjunctive acupressure on one (n=32) or two days (n=31) and standard care (n=31). Acupressure in the form of 10 minutes of bilateral stimulation at five acupoints was administered per treatment session. Weaning indices were collected on two days before, right after, and at 0.5 hrs, 1 hr, 1.5 hrs, 2 hrs, 2.5 hrs, 3 hrs, 3.5 hrs, and 4 hrs after the start of treatment.Results. There were statistically significant improvements in tidal volumes and index of rapid shallow breathing in the one-day and two-day adjunctive acupressure study arms compared to the standard care arm immediately after acupressure and persisting until 0.5, 1 hr, and 2 hrs after adjustment for covariates.Conclusions. In the stable ventilated coma patient, adjunctive acupressure contributes to improvements in tidal volumes and the index of rapid shallow breathing, the two indices most critical for weaning patients from mechanical ventilation. These effects tend to be immediate and likely to be sustained for 1 to 2 hours.

scholarly journals Success or failure predictive indexes of extubation in renal transplants patients under mechanical ventilation – pilot study

2020 ◽  
pp. 1-7
Author(s):  
Luciana Domingues Angelo da Silva ◽  
Marcella M. Musumeci F. Almeida ◽  
Matheus Oliveira Quaresma ◽  
Talita Castro ◽  
Mariana Ares Santos ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Oxygenation Index ◽  
Extubation Failure ◽  
Inspiratory Pressure ◽  
Major Health Problem ◽  
Maximum Inspiratory Pressure ◽  
Transplant Patients ◽  
Rapid Shallow Breathing Index ◽  
Shallow Breathing ◽  
Rapid Shallow Breathing

Introduction: Currently, chronic kidney disease (CKD) is a major health problem and in the most severe conditions, kidney transplantation is an alternative treatment. However immunosuppression induced these patients to respiratory complications and endotracheal intubation. In order to assist the decision of the best time for weaning and extubation of these patients, there are predictive indexes that should be considered in preliminary assesment. Objective: To check the capacity of predictive indexes for weaning of mechanical ventilation, rapid shallow breathing index (RSBI), oxygenation rate (PaO2 /FiO2 ) and maximum inspiratory pressure (MIP) in predicting the success or extubation failure in kidney transplant patients. Methods: This study is a prospective cohort carried out with patients aged over 18, under mechanical ventilation for more than 24 hours. The patients were submitted to the Spontaneous Breathing Test, also the assessment of the Rapid Shallow Breathing Index, oxygenation index (PaO2 /FiO2 ), and maximum inspiratory pressure (MIP) and they were observed during 48 hours after to evaluate the success and extubation failure. Results: A total of 106 patients were eligible, and 20 of these were included with mean age of 46.9 ± 3.06 years and 14 of the subjects were male. Three patients showed extubation failure, and needed to have reintubation within the period of 48 hours as considered. Conclusion: The indices to predict weaning of mechanical ventilation, when within the expected normal values, seem to be able to predict extubation, with the exception of MIP that, even in cases of success, showed itself to be at levels lower than the predicted percentage.

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

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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