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Integrated ultrasound protocol in predicting weaning success and extubation failure: a prospective observational study
BACKGROUND: Difficulty in weaning from mechanical ventilation is encountered in appro-ximately 20% of patients in the intensive care unit. We assessed the utility of a combined lung, diaphragmatic, and cardiac ultrasound protocol to predict extubation failure. METHODS: All patients extubated followi...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Termedia Publishing House
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10156490/ https://www.ncbi.nlm.nih.gov/pubmed/35413786 http://dx.doi.org/10.5114/ait.2022.115351 |
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author | Kundu, Riddhi Baidya, Dalim K. Anand, Rahul K. Maitra, Souvik Soni, Kapil D. Subramanium, Rajeshwari |
author_facet | Kundu, Riddhi Baidya, Dalim K. Anand, Rahul K. Maitra, Souvik Soni, Kapil D. Subramanium, Rajeshwari |
author_sort | Kundu, Riddhi |
collection | PubMed |
description | BACKGROUND: Difficulty in weaning from mechanical ventilation is encountered in appro-ximately 20% of patients in the intensive care unit. We assessed the utility of a combined lung, diaphragmatic, and cardiac ultrasound protocol to predict extubation failure. METHODS: All patients extubated following a successful spontaneous breathing trial (SBT) were included in the study. Lung ultrasonography score (LUS), diaphragmatic thickness fraction (DTF), changes in velocity time integral (VTI) to passive leg raise at the beginning of SBT, and change in LUS following SBT were recorded. RESULTS: A total of 60 patients who underwent successful SBT were included in the study. Twenty-seven patients required either non-invasive or invasive mechanical ventilation during the next 48 hours and were classified as weaning failure (Group F). The remaining 33 patients were designated as weaning success (Group S). Compared to group S, patients in Group F had significantly longer ICU length of stay (6.96 ± 4.30 days vs. 11.66 ± 3.85 days, P < 0.001), higher LUS change during SBT (1 [0–2] vs. 2 [1–4], P < 0.001), lower DTF (30.87 ± 5.32 vs. 27.88 ± 6.24, P = 0.04), and showed lower VTI increment to PLR (13.63 ± 3.44 vs. 9.11 ± 4.59, P < 0.001). Using a binary logistic regression model, DTF < 26% (odds ratio 6.20, 95% CI: 1.06–36.04) and VTI change to PLR < 10.2% (odds ratio 6.16, 95% CI: 1.14–33.13) were found to be significant predictors of weaning failure (P < 0.05). The AUROC for VTI and DTF for predicting weaning failure were 0.79 and 0.64, respectively. CONCLUSIONS: An integrated ultrasound protocol using a combination of lung, diaphragm, and cardiac sonography was a reliable predictor of weaning failure. |
format | Online Article Text |
id | pubmed-10156490 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Termedia Publishing House |
record_format | MEDLINE/PubMed |
spelling | pubmed-101564902023-05-17 Integrated ultrasound protocol in predicting weaning success and extubation failure: a prospective observational study Kundu, Riddhi Baidya, Dalim K. Anand, Rahul K. Maitra, Souvik Soni, Kapil D. Subramanium, Rajeshwari Anaesthesiol Intensive Ther Original and Clinical Articles BACKGROUND: Difficulty in weaning from mechanical ventilation is encountered in appro-ximately 20% of patients in the intensive care unit. We assessed the utility of a combined lung, diaphragmatic, and cardiac ultrasound protocol to predict extubation failure. METHODS: All patients extubated following a successful spontaneous breathing trial (SBT) were included in the study. Lung ultrasonography score (LUS), diaphragmatic thickness fraction (DTF), changes in velocity time integral (VTI) to passive leg raise at the beginning of SBT, and change in LUS following SBT were recorded. RESULTS: A total of 60 patients who underwent successful SBT were included in the study. Twenty-seven patients required either non-invasive or invasive mechanical ventilation during the next 48 hours and were classified as weaning failure (Group F). The remaining 33 patients were designated as weaning success (Group S). Compared to group S, patients in Group F had significantly longer ICU length of stay (6.96 ± 4.30 days vs. 11.66 ± 3.85 days, P < 0.001), higher LUS change during SBT (1 [0–2] vs. 2 [1–4], P < 0.001), lower DTF (30.87 ± 5.32 vs. 27.88 ± 6.24, P = 0.04), and showed lower VTI increment to PLR (13.63 ± 3.44 vs. 9.11 ± 4.59, P < 0.001). Using a binary logistic regression model, DTF < 26% (odds ratio 6.20, 95% CI: 1.06–36.04) and VTI change to PLR < 10.2% (odds ratio 6.16, 95% CI: 1.14–33.13) were found to be significant predictors of weaning failure (P < 0.05). The AUROC for VTI and DTF for predicting weaning failure were 0.79 and 0.64, respectively. CONCLUSIONS: An integrated ultrasound protocol using a combination of lung, diaphragm, and cardiac sonography was a reliable predictor of weaning failure. Termedia Publishing House 2022-04-12 /pmc/articles/PMC10156490/ /pubmed/35413786 http://dx.doi.org/10.5114/ait.2022.115351 Text en Copyright © Polish Society of Anaesthesiology and Intensive Therapy https://creativecommons.org/licenses/by-nc-sa/4.0/This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/ (https://creativecommons.org/licenses/by-nc-sa/4.0/) ), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license. |
spellingShingle | Original and Clinical Articles Kundu, Riddhi Baidya, Dalim K. Anand, Rahul K. Maitra, Souvik Soni, Kapil D. Subramanium, Rajeshwari Integrated ultrasound protocol in predicting weaning success and extubation failure: a prospective observational study |
title | Integrated ultrasound protocol in predicting weaning success and extubation failure: a prospective observational study |
title_full | Integrated ultrasound protocol in predicting weaning success and extubation failure: a prospective observational study |
title_fullStr | Integrated ultrasound protocol in predicting weaning success and extubation failure: a prospective observational study |
title_full_unstemmed | Integrated ultrasound protocol in predicting weaning success and extubation failure: a prospective observational study |
title_short | Integrated ultrasound protocol in predicting weaning success and extubation failure: a prospective observational study |
title_sort | integrated ultrasound protocol in predicting weaning success and extubation failure: a prospective observational study |
topic | Original and Clinical Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10156490/ https://www.ncbi.nlm.nih.gov/pubmed/35413786 http://dx.doi.org/10.5114/ait.2022.115351 |
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