Sonographic assessment of diaphragmatic thickening and excursion as predictors of weaning success in the intensive care unit: A prospective observational study.

Content Provider	Europe PMC
Author	Kaur, Amandeep Sharma, Shruti Singh, Vikram P. Krishna, M. Ravi Gautam, Parshotam L. Singh, Gagandeep
Copyright Year	2022
Abstract	Background and Aims:Ultrasonographic assessment of diaphragmatic function can be a useful bedside tool in the weaning and extubation of mechanically ventilated patients, especially in patients with difficult weaning, in whom diaphragmatic weakness is suspected. Thus, this study was planned to assess the role of bedside sonographic assessment of diaphragmatic indices such as diaphragmatic thickening fraction (DTf) and diaphragmatic excursion (DE) in predicting successful extubation or extubation failure in weaning eligible patients by comparing the measurements with outcome.Methods:This prospective observational study was conducted on 50 mechanically ventilated, weaning-ready patients during the spontaneous breathing trial (SBT). The DE and DTf of patients were noted along with conventional parameters of weaning. Probability value <0.05 was considered statistically significant. Receiver operating characteristic (ROC) curves were used for analysis. Area under the curve (AUC) was measured, and sensitivity and specificity for different cut-off values were estimated.Results:Out of 50 patients, 15 (30%) had SBT failure and 4 had extubation failure. The group with SBT failure had significantly higher rapid shallow breathing index (RSBI) and airway occlusion pressure (P0.1s), whereas DE and DTf were lower compared to the SBT successful group. Strong correlation existed between RSBI, DTf, DE and P0.1s. DTf of nearly 24% (sensitivity 93.5%, specificity 94.7%) and DE of 1.10 cm (84% sensitivity, 89.5% specificity) were associated with best outcome.Conclusion:Along with conventional parameters of weaning, sonographic assessment of diaphragmatic parameters can be useful in predicting the success of SBT and in avoiding unnecessary extubation failures and thereby help in achieving a successful weaning outcome.
ISSN	00195049
Volume Number	66
PubMed Central reference number	PMC9795502
Issue Number	11
PubMed reference number	36590197
Journal	Indian Journal of Anaesthesia [Indian J Anaesth]
e-ISSN	09762817
DOI	10.4103/ija.ija_312_22
Language	English
Publisher	Wolters Kluwer - Medknow
Publisher Date	2022-11-18
Publisher Place	India
Access Restriction	Open
Rights License	This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Copyright: © 2022 Indian Journal of Anaesthesia
Subject Keyword	Diaphragm ultrasonography weaning
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine