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

BACKGROUND: In 3%–19% of patients, reintubation is needed 48–72 hours following extubation, which increases intensive care unit (ICU) morbidity, mortality, and expenses. Extubation failure is frequently caused by diaphragm dysfunction. Ultrasonography can be used to determine the mobility and thickn...

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Autores principales: Alam, Mohammad Jhahidul, Roy, Simanta, Iktidar, Mohammad Azmain, Padma, Fahmida Khatun, Nipun, Khairul Islam, Chowdhury, Sreshtha, Nath, Ranjan Kumar, Rashid, Harun-Or
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Critical Care Medicine 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8918710/
https://www.ncbi.nlm.nih.gov/pubmed/35081706
http://dx.doi.org/10.4266/acc.2021.01354
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author Alam, Mohammad Jhahidul
Roy, Simanta
Iktidar, Mohammad Azmain
Padma, Fahmida Khatun
Nipun, Khairul Islam
Chowdhury, Sreshtha
Nath, Ranjan Kumar
Rashid, Harun-Or
author_facet Alam, Mohammad Jhahidul
Roy, Simanta
Iktidar, Mohammad Azmain
Padma, Fahmida Khatun
Nipun, Khairul Islam
Chowdhury, Sreshtha
Nath, Ranjan Kumar
Rashid, Harun-Or
author_sort Alam, Mohammad Jhahidul
collection PubMed
description BACKGROUND: In 3%–19% of patients, reintubation is needed 48–72 hours following extubation, which increases intensive care unit (ICU) morbidity, mortality, and expenses. Extubation failure is frequently caused by diaphragm dysfunction. Ultrasonography can be used to determine the mobility and thickness of the diaphragm. This study looked at the role of diaphragm excursion (DE) and thickening fraction in predicting successful extubation from mechanical ventilation. METHODS: Thirty-one patients were extubated with the advice of an ICU consultant using the ICU weaning regimen and diaphragm ultrasonography was performed. Ultrasound DE and thickening fraction were measured three times: at the commencement of the T-piece experiment, at 10 minutes, and immediately before extubation. All patients' parameters were monitored for 48 hours after extubation. Rapid shallow breathing index (RSBI) was also measured at the same time. RESULTS: Successful extubation was significantly correlated with DE (P<0.001). Receiver curve analysis for DE to predict successful extubation revealed good properties (area under the curve [AUC], 0.83; P<0.001); sensitivity, 77.8%; specificity, 84.6%; positive predictive value (PPV), 84.6 %; negative predictive value (NPV), 73.3% while cut-off value, 11.43 mm. Diaphragm thickening fraction (DTF) also revealed moderate curve properties (AUC, 0.69; P=0.06); sensitivity, 61.1%; specificity, 84.6%; PPV, 87.5%; NPV, 61.1% with cut-off value 22.33% although former one was slightly better. RSBI could not reach good receiver operating characteristic value at cut-off points 100 breaths/min/L (AUC, 0.58; P=0.47); sensitivity, 66.7%; specificity, 53.8%; PPV, 66.7%; NPV, 53.8%). CONCLUSIONS: To decrease the rate of reintubation, DE and DTF are better indicators of successful extubation. DE outperforms DTF.
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spelling pubmed-89187102022-03-21 Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index Alam, Mohammad Jhahidul Roy, Simanta Iktidar, Mohammad Azmain Padma, Fahmida Khatun Nipun, Khairul Islam Chowdhury, Sreshtha Nath, Ranjan Kumar Rashid, Harun-Or Acute Crit Care Original Article BACKGROUND: In 3%–19% of patients, reintubation is needed 48–72 hours following extubation, which increases intensive care unit (ICU) morbidity, mortality, and expenses. Extubation failure is frequently caused by diaphragm dysfunction. Ultrasonography can be used to determine the mobility and thickness of the diaphragm. This study looked at the role of diaphragm excursion (DE) and thickening fraction in predicting successful extubation from mechanical ventilation. METHODS: Thirty-one patients were extubated with the advice of an ICU consultant using the ICU weaning regimen and diaphragm ultrasonography was performed. Ultrasound DE and thickening fraction were measured three times: at the commencement of the T-piece experiment, at 10 minutes, and immediately before extubation. All patients' parameters were monitored for 48 hours after extubation. Rapid shallow breathing index (RSBI) was also measured at the same time. RESULTS: Successful extubation was significantly correlated with DE (P<0.001). Receiver curve analysis for DE to predict successful extubation revealed good properties (area under the curve [AUC], 0.83; P<0.001); sensitivity, 77.8%; specificity, 84.6%; positive predictive value (PPV), 84.6 %; negative predictive value (NPV), 73.3% while cut-off value, 11.43 mm. Diaphragm thickening fraction (DTF) also revealed moderate curve properties (AUC, 0.69; P=0.06); sensitivity, 61.1%; specificity, 84.6%; PPV, 87.5%; NPV, 61.1% with cut-off value 22.33% although former one was slightly better. RSBI could not reach good receiver operating characteristic value at cut-off points 100 breaths/min/L (AUC, 0.58; P=0.47); sensitivity, 66.7%; specificity, 53.8%; PPV, 66.7%; NPV, 53.8%). CONCLUSIONS: To decrease the rate of reintubation, DE and DTF are better indicators of successful extubation. DE outperforms DTF. Korean Society of Critical Care Medicine 2022-02 2022-01-11 /pmc/articles/PMC8918710/ /pubmed/35081706 http://dx.doi.org/10.4266/acc.2021.01354 Text en Copyright © 2022 The Korean Society of Critical Care Medicine https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Alam, Mohammad Jhahidul
Roy, Simanta
Iktidar, Mohammad Azmain
Padma, Fahmida Khatun
Nipun, Khairul Islam
Chowdhury, Sreshtha
Nath, Ranjan Kumar
Rashid, Harun-Or
Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index
title Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index
title_full Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index
title_fullStr Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index
title_full_unstemmed Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index
title_short Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index
title_sort diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8918710/
https://www.ncbi.nlm.nih.gov/pubmed/35081706
http://dx.doi.org/10.4266/acc.2021.01354
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