Usefulness of diaphragmatic ultrasound in predicting extubation success

F Varón-Vega; Á Hernández; M López; E Cáceres; L F Giraldo-Cadavid; A M Uribe-Hernandez; S Crevoisier

doi:10.1016/j.medin.2019.10.007

Usefulness of diaphragmatic ultrasound in predicting extubation success

Med Intensiva (Engl Ed). 2021 May;45(4):226-233. doi: 10.1016/j.medin.2019.10.007. Epub 2019 Dec 20.

[Article in English, Spanish]

Authors

F Varón-Vega¹, Á Hernández², M López², E Cáceres², L F Giraldo-Cadavid³, A M Uribe-Hernandez⁴, S Crevoisier⁵

Affiliations

¹ Unidad de Cuidado Intensivo Médico, Fundación Neumológica Colombiana, Bogotá, Colombia; Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia; Departamento de Anestesiología y Cuidados Intensivos, Universidad de Navarra, Pamplona, España.
² Unidad de Cuidado Intensivo Médico, Fundación Neumológica Colombiana, Bogotá, Colombia.
³ Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia; Departamento de Epidemiología y de Medicina Interna, Universidad de La Sabana, Chía, Colombia.
⁴ Unidad de Cuidado Intensivo Médico, Fundación Neumológica Colombiana, Bogotá, Colombia; Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia; Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia. Electronic address: [email protected].
⁵ Medicina Crítica y Cuidado Intensivo, Universidad de La Sabana, Chía, Colombia.

PMID: 31870509
DOI: 10.1016/j.medin.2019.10.007

Abstract

Objective: To evaluate the diagnostic accuracy of diaphragmatic ultrasound in predicting extubation success.

Design: A diagnostic accuracy study was carried out.

Scope: Intensive Care Unit of an Academic hospital in the city of Bogotá (Colombia).

Patients or participants: A consecutive sample of patients >18 years of age subjected to invasive mechanical ventilation for >48h.

Interventions: Diaphragmatic ultrasound evaluation at the end of spontaneous ventilation testing.

Main variables of interest: Diaphragmatic excursion (DE, cm), inspiration time (TPIA_dia, s), diaphragm contraction speed (DE/TPIA_dia, cm/s) and total time (Ttot, s) were evaluated, together with thickening fraction (TF_di, %).

Results: A total of 84 patients were included, 79.8% (n=67) with successful extubation and 20.2% (n=17) with failed extubation. The variable with the best discriminatory capacity in predicting extubation success was diaphragm contraction speed, with AUC-ROC 0.70 (p=0.008).

Conclusions: Diaphragm contraction speed exhibited acceptable discriminatory capacity. Ultrasound could be part of a multifactorial approach in the extubation process.

Keywords: Airway extubation; Artificial; Critical illness; Destete del ventilador; Diafragma/diagnóstico por imagen; Diaphragm/diagnostic imaging; Enfermedad crítica; Extubación de la vía aérea; Intensive care units; Predictive value of tests; Respiración; Respiration; Retirada de la ventilación; Sensibilidad y especificidad; Sensitivity and specificity; Ultrasonografía; Ultrasonography; Unidades de cuidados intensivos; Valor predictivo de las pruebas; Ventilator weaning; Weaning from ventilation.