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The power of diaphragm ultrasonography in predicting weaning success

Year 2022, Volume: 47 Issue: 2, 747 - 755, 30.06.2022
https://doi.org/10.17826/cumj.1037159

Abstract

Purpose: The aim of this study; to evaluate the effects of diaphragm thickness on weaning with ultrasonography (USG).
Materials and Methods: In this prospective study; demographic characteristics of the patients, indications for hospitalization in the intensive care unit and mechanical ventilation, comorbidity, diaphragm thickness, Sequential Organ Failure Assessment (SOFA) score and Simplified Acute Physiology Score (SAPS) II, mortality rate, peripheral oxygen saturation (SpO2), invasive mechanical ventilator (IMV) duration, minute volume, respiratory rate (RR), expiratory volumes (VTE), RSBI values were recorded. The patients were ventilated spontaneously for 30 minutes in pressure support (PS) mode in IMV. Diaphragm thickness (DT) was measured using a 7-10 MHz linear ultrasound probe set to B mode. The right hemidiaphragm was visualized in the midaxillary line between the 8th and 10th intercostal spaces, at the junction of the diaphragm and rib cage. After the measurements were stabilized, the patients were taken to the T-tube for one hour. The patients who successfully completed T-tube spontaneous breathing trials (SBT) were extubated. The patients were divided into two groups as successful and unsuccessful weaning.
Results: A total of 72 patients were evaluated by meeting the inclusion criteria. Four of the patients were excluded from the study because they received IMV support for less than 24 hours. There was no difference between the groups in the ratios of diaphragm thickness index (DTI) and diaphragmatic thickening fraction (DTF). The thickness measurements of the diaphragm, defined as diaphragm thickness at the end of inspiration (DTV) and diaphragm thickness at the end of expiration (DFRV), were higher in the successful weaning group. The best threshold value of DTV to predict weaning success was found to be 0.72 and DFRV value to be 0.669.
Conclusion: Weaning success is closely related to diaphragm functions, diaphragm thickness parameters and lung capacities. USG is a practical, bedside, noninvasive method that can be used to evaluate the diaphragm. DTV and DFRV are among the parameters that can predict success in the weaning process. DTF and DTI were found to be insufficient in predicting weaning success.

References

  • 1. Pettenuzzo T, Fan E. 2016 Year in Review: Mechanical Ventilation. Respir Care. 2017;62(5):629-35.
  • 2. Windisch W, Dellweg D, Geiseler J, Westhoff M, Pfeifer M, Suchi S, et al. Prolonged Weaning from Mechanical Ventilation. Dtsch Arztebl Int. 2020;117(12):197-204.
  • 3. Zaponi R, Osaku E, Abentroth L, Silva MM, Jaskowiak J, Ogasawara S, et al. The impact of tracheostomy timing on the duration and complications of mechanical ventilation. Curr Respir Med Rev. 2019;15(4):272–80.
  • 4. Khemani RG, Hotz J, Morzov R, Flink RC, Kamerkar A, et al. Pediatric extubation readiness tests should not use pressure support. Intensive Care Med. 2016;42(8):1214-22.
  • 5. Yang KL, Tobin MJ: A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med. 1991;324:1445-50.
  • 6. Schepens T, Dianti J. Diaphragm protection: what should we target? Curr Opin Crit Care. 2020;26(1):35–40.
  • 7. DiNino E, Gartman EJ, Sethi JM, McCool FD: Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax. 2014;69:423-7.
  • 8. Molina Peña ME, Sánchez CM, Rodríguez-Triviño CY. Physiopathological mechanisms of diaphragmatic dysfunction associated with mechanical ventilation. Rev Esp Anestesiol Reanim. 2020;67(4):195–203.
  • 9. Goligher EC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MSet al. Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes. Am J Respir Crit Care Med. 2018;197(2):204–13.
  • 10. Schepens T, Fard S, Goligher EC. Assessing diaphragmatic function. Respir Care. 2020;65(6):807–19.
  • 11. Vetrugno L, Guadagnin GM, Barbariol F, Langiano N, Zangrillo A, Bove T. Ultrasound imaging for diaphragm dysfunction: a narrative literature review. J Cardiothorac Vasc Anesth. 2019;33(9):2525–36.
  • 12. Goligher EC, Fan E, Herridge MS, Murray A, Vorona S, Brace D, et al. Evolution of diaphragm thickness during mechanical ventilation impact of inspiratory efort. Am J Respir Critic Care Med. 2015;192(9):1080–8.
  • 13. Zhu Z, Li J, Yang D, Gao F, Du L, Yang M. Ultrasonographic evaluation of diaphragm thickness and excursion in patients with cervical spinal cord injury. J Spinal Cord Med. 2021;44(5):742-47.
  • 14. McCool FD, Oyieng’o DO, Koo P. The utility of diaphragm ultrasound in reducing time to extubation. Lung. 2020;198(3):499–505.
  • 15. Samanta S, Singh RK, Baronia AK, Poddar B, Azim A, Gurjar M. Diaphragm thickening fraction to predict weaning-a prospective exploratory study. J Intensive Care. 2017;5:62.
  • 16. Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29(5):1033-56.
  • 17. Gursel G, Inci K, Alasgarova Z. Can Diaphragm Dysfunction Be Reliably Evaluated with Pocket-Sized Ultrasound Devices in Intensive Care Unit? Crit Care Res Pract. 2018;2018:5192647.
  • 18.Nekludova GV, Avdeev SN. Possibilities of ultrasound research of the diaphragm. Ter Arkh. 2019;91(3):86–92.
  • 19. Spadaro S, Grasso S, Mauri T, Dalla Corte F, Alvisi V, Ragazzi R, et al. Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index. Crit Care. 2016;20(1):305.
  • 20. Gok F, Mercan A, Kilicaslan A, Sarkilar G, Yosunkaya A. Diaphragm and Lung Ultrasonography During Weaning From Mechanical Ventilation in Critically Ill Patients. Cureus. 2021;13(5):e15057.
  • 21.Vivier E, Mekontso Dessap A, Dimassi S, Vargas F, Lyazidi A, Thille AW, et al. Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation. Intensive Care Med. 2012;38:796-803.
  • 22. Umbrello M, Formenti P, Longhi D, Galimberti A, Piva I, Pezzi A, et al. Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study. Crit Care. 2015;19(1):161.
  • 23.Blumhof S, Wheeler D, Thomas K, McCool FD, Mora J: Change in diaphragmatic thickness during the respiratory cycle predicts extubation success at various levels of pressure support ventilation. Lung. 2016;194:519-25.
  • 24.Umbrello M, Formenti P. Ultrasonographic assessment of diaphragm function in critically ill subjects. Respir Care 2016;61:542-55.
  • 25. Palkar A, Narasimhan M, Greenberg H, Singh K, Koenig S, et al. Diaphragm Excursion-Time Index: A New Parameter Using Ultrasonography to Predict Extubation Outcome. Chest. 2018;153(5):1213-20.
  • 26. Dubé BP, Dres M, Mayaux J, Demiri S, Similowski T, Demoule A. Ultrasound evaluation of diaphragm function in mechanically ventilated patients: comparison to phrenic stimulation and prognostic implications. Thorax. 2017;72(9):811-18.
  • 27.Llamas-Alvarez AM, Tenza-Lozano EM, Latour-Perez J. Diaphragm and lung ultrasound to predict weaning outcome: systematic review and meta-analysis. Chest 2017;152:1140-50.
  • 28. Abdelwahed WM, Abd Elghafar MS, Amr YM, Alsherif SEI, Eltomey MA. Prospective study: Diaphragmatic thickness as a predictor index for weaning from mechanical ventilation. J Crit Care. 2019;52:10-5.
  • 29. Turton P, ALAidarous S, Welters I. A narrative review of diaphragm ultrasound to predict weaning from mechanical ventilation: where are we and where are we heading? Ultrasound J. 2019;11:2-7.

Diyafram ultrasonografisinin weaning başarısını tahmin etmedeki gücü

Year 2022, Volume: 47 Issue: 2, 747 - 755, 30.06.2022
https://doi.org/10.17826/cumj.1037159

Abstract

Amaç: Bu çalışmada amaç; diyafram kalınlığının weaning üzerine etkilerini ultrasonografi (USG) ile değerlendirmektir.
Gereç ve Yöntem: Prospektif olarak yapılan bu çalışmada; hastaların demografik özellikleri, yoğun bakıma yatış ve mekanik ventilasyon endikasyonları, ek hastalıkları, diyafram kalınlığı, Sıralı Organ Yetmezliği Değerlendirmesi (SOFA) skoru ve Basitleştirilmiş Akut Fizyoloji Skoru (SAPS) II, mortalite oranı, periferik oksijen satürasyonu (SpO2), IMV süresi, dakika hacmi, solunum sayısı (RR), ekspiratuar hacimleri, RSBI değerleri kaydedildi.Hastalar invaziv mekanik ventilatör (IMV) basınç desteği (PS) modunda 30 dakika boyunca spontan olarak ventile edildi . Diyafram kalınlığı (DT), B moduna ayarlanmış 7-10 MHz lineer ultrason probu kullanılarak ölçüldü. Sağ hemidiyafram, 8. ve 10. interkostal boşluklar arasındaki midaksiller çizgide diyafram ve göğüs kafesinin birleştiği bölgede görüntülendi. Ölçümler sonrasında hastalar stabil hale geldikten sonra 1 saat boyunca T-tüpe alındı. T-tüpte spontan solunum denemeleri (SBT)'ni başarıyla tamamlayan hastalar ekstübe edildi. Hastalar başarılı ve başarısız weaning olmak üzere 2 gruba ayrıldı.
Bulgular: Toplam 72 hasta çalışmaya dahil edilme kriterlerini sağlayarak değerlendirilmeye alındı. Hastaların 4 tanesi 24 saatten daha kısa süre IMV desteği aldığı için çalışma dışı bırakıldı. Diyafram kalınlık indeksi (DTI) ve diyafram kalınlaşma fraksiyonu (DTF) oranlarında gruplar arasında bir farklılık gözlenmedi. İnspirasyon sonunu diyafram kalınlığı (DTV) ve ekspirasyon sonunu diyafram kalınlığı (DFRV) olarak tanımlanan diyaframın kalınlık ölçümleri başarılı weaning grubunda daha yüksekti. Weaning başarısını tahmin etmek için DTV'nin en iyi eşik değeri 0.72, DFRV değeri 0.669 olarak bulundu.
Sonuç: Weaning başarısı diyafram fonksiyonları, diyafram kalınlık parametreleri ve akciğer kapasiteleri ile yakından ilişkilidir. USG, diyaframı değerlendirmek için kullanılabilecek pratik, hasta başı uygulanabilen, noninvaziv bir yöntemdir. DTV ve DFRV weaning sürecinde başarıyı tahmin edebilecek parametreler arasındadır. DTF ve DTI weaning başarısını öngörmede yetersiz bulundu.

References

  • 1. Pettenuzzo T, Fan E. 2016 Year in Review: Mechanical Ventilation. Respir Care. 2017;62(5):629-35.
  • 2. Windisch W, Dellweg D, Geiseler J, Westhoff M, Pfeifer M, Suchi S, et al. Prolonged Weaning from Mechanical Ventilation. Dtsch Arztebl Int. 2020;117(12):197-204.
  • 3. Zaponi R, Osaku E, Abentroth L, Silva MM, Jaskowiak J, Ogasawara S, et al. The impact of tracheostomy timing on the duration and complications of mechanical ventilation. Curr Respir Med Rev. 2019;15(4):272–80.
  • 4. Khemani RG, Hotz J, Morzov R, Flink RC, Kamerkar A, et al. Pediatric extubation readiness tests should not use pressure support. Intensive Care Med. 2016;42(8):1214-22.
  • 5. Yang KL, Tobin MJ: A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med. 1991;324:1445-50.
  • 6. Schepens T, Dianti J. Diaphragm protection: what should we target? Curr Opin Crit Care. 2020;26(1):35–40.
  • 7. DiNino E, Gartman EJ, Sethi JM, McCool FD: Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax. 2014;69:423-7.
  • 8. Molina Peña ME, Sánchez CM, Rodríguez-Triviño CY. Physiopathological mechanisms of diaphragmatic dysfunction associated with mechanical ventilation. Rev Esp Anestesiol Reanim. 2020;67(4):195–203.
  • 9. Goligher EC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MSet al. Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes. Am J Respir Crit Care Med. 2018;197(2):204–13.
  • 10. Schepens T, Fard S, Goligher EC. Assessing diaphragmatic function. Respir Care. 2020;65(6):807–19.
  • 11. Vetrugno L, Guadagnin GM, Barbariol F, Langiano N, Zangrillo A, Bove T. Ultrasound imaging for diaphragm dysfunction: a narrative literature review. J Cardiothorac Vasc Anesth. 2019;33(9):2525–36.
  • 12. Goligher EC, Fan E, Herridge MS, Murray A, Vorona S, Brace D, et al. Evolution of diaphragm thickness during mechanical ventilation impact of inspiratory efort. Am J Respir Critic Care Med. 2015;192(9):1080–8.
  • 13. Zhu Z, Li J, Yang D, Gao F, Du L, Yang M. Ultrasonographic evaluation of diaphragm thickness and excursion in patients with cervical spinal cord injury. J Spinal Cord Med. 2021;44(5):742-47.
  • 14. McCool FD, Oyieng’o DO, Koo P. The utility of diaphragm ultrasound in reducing time to extubation. Lung. 2020;198(3):499–505.
  • 15. Samanta S, Singh RK, Baronia AK, Poddar B, Azim A, Gurjar M. Diaphragm thickening fraction to predict weaning-a prospective exploratory study. J Intensive Care. 2017;5:62.
  • 16. Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29(5):1033-56.
  • 17. Gursel G, Inci K, Alasgarova Z. Can Diaphragm Dysfunction Be Reliably Evaluated with Pocket-Sized Ultrasound Devices in Intensive Care Unit? Crit Care Res Pract. 2018;2018:5192647.
  • 18.Nekludova GV, Avdeev SN. Possibilities of ultrasound research of the diaphragm. Ter Arkh. 2019;91(3):86–92.
  • 19. Spadaro S, Grasso S, Mauri T, Dalla Corte F, Alvisi V, Ragazzi R, et al. Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index. Crit Care. 2016;20(1):305.
  • 20. Gok F, Mercan A, Kilicaslan A, Sarkilar G, Yosunkaya A. Diaphragm and Lung Ultrasonography During Weaning From Mechanical Ventilation in Critically Ill Patients. Cureus. 2021;13(5):e15057.
  • 21.Vivier E, Mekontso Dessap A, Dimassi S, Vargas F, Lyazidi A, Thille AW, et al. Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation. Intensive Care Med. 2012;38:796-803.
  • 22. Umbrello M, Formenti P, Longhi D, Galimberti A, Piva I, Pezzi A, et al. Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study. Crit Care. 2015;19(1):161.
  • 23.Blumhof S, Wheeler D, Thomas K, McCool FD, Mora J: Change in diaphragmatic thickness during the respiratory cycle predicts extubation success at various levels of pressure support ventilation. Lung. 2016;194:519-25.
  • 24.Umbrello M, Formenti P. Ultrasonographic assessment of diaphragm function in critically ill subjects. Respir Care 2016;61:542-55.
  • 25. Palkar A, Narasimhan M, Greenberg H, Singh K, Koenig S, et al. Diaphragm Excursion-Time Index: A New Parameter Using Ultrasonography to Predict Extubation Outcome. Chest. 2018;153(5):1213-20.
  • 26. Dubé BP, Dres M, Mayaux J, Demiri S, Similowski T, Demoule A. Ultrasound evaluation of diaphragm function in mechanically ventilated patients: comparison to phrenic stimulation and prognostic implications. Thorax. 2017;72(9):811-18.
  • 27.Llamas-Alvarez AM, Tenza-Lozano EM, Latour-Perez J. Diaphragm and lung ultrasound to predict weaning outcome: systematic review and meta-analysis. Chest 2017;152:1140-50.
  • 28. Abdelwahed WM, Abd Elghafar MS, Amr YM, Alsherif SEI, Eltomey MA. Prospective study: Diaphragmatic thickness as a predictor index for weaning from mechanical ventilation. J Crit Care. 2019;52:10-5.
  • 29. Turton P, ALAidarous S, Welters I. A narrative review of diaphragm ultrasound to predict weaning from mechanical ventilation: where are we and where are we heading? Ultrasound J. 2019;11:2-7.
There are 29 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research
Authors

Mine Altınkaya Çavuş 0000-0003-2584-0463

Şerife Gökbulut Bektaş 0000-0001-6057-723X

Hilal Sipahioğlu 0000-0002-7884-2094

Gözde Ertürk Zararsız This is me 0000-0002-5495-7540

Sema Turan 0000-0003-2443-0390

Publication Date June 30, 2022
Acceptance Date May 5, 2022
Published in Issue Year 2022 Volume: 47 Issue: 2

Cite

MLA Altınkaya Çavuş, Mine et al. “The Power of Diaphragm Ultrasonography in Predicting Weaning Success”. Cukurova Medical Journal, vol. 47, no. 2, 2022, pp. 747-55, doi:10.17826/cumj.1037159.