From: Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 1
Variables | Study | Major findings |
---|---|---|
Diaphragm excursion (DE) | Jiang et al. [61] | Mean values of liver and spleen displacement during SBTs were higher in the successfully weaned group. Sensitivity and specificity for predicting successful extubation were 84.4% and 82.6%, respectively |
Spadaro et al. [62] | By replacing tidal volume (VTe) with DE in the formula for the Rapid Shallow Breathing Index (RSBI = RR/VTe), the authors created a new index called the diaphragmatic-RSBI (D-RSBI) The use of diaphragmatic excursion makes this index more accurate than the traditional rapid shallow breathing index in predicting outcome from weaning | |
Kim et al. [43] | The authors describe an association between diaphragmatic dysfunction (DE < 10 mm obtained by M-Mode ultrasonography), a prolonged weaning period, and early or delayed weaning failures | |
Luo et al. [63] | The authors find that a DE cut-off value < 12.6 mm was the most reliable predictor of reintubation within 1 week (sensitivity 80%, negative specificity 68.4%) | |
Garrido-Aguirre et al. [64] | The authors propose a new weaning index (ULDIMex) that takes into consideration inspiration time (a), expiration time (b), and DE (c). With the conceived formula (a + b)c/2, the authors identified a cut-off slope value of 4.06 cm/s for ULDIMex in successfully weaned patients, with a negative predictive value of 96.5% | |
Palkar et al. [65] | Greater diaphragm excursion, a longer inspiratory time, and a smaller decrease in the diaphragmatic excursion-time (E-T) index during SBT may help to predict successful extubation | |
Carrie et al. [66] | According to the authors, DE was unable by itself to predict weaning failure with low sensitivity and specificity 59% and 71%, respectively | |
Diaphragm thickening fraction (DTF) | Jung et al. [67] | The authors reveal a significantly lower mean DTF in patients requiring reintubation versus patients who did not (12% vs. 20%, p = 0.008) |
Samanta et al. [68] | DTF assessment of the right diaphragm during pressure support ventilation (PSV) may be employed to predict successful weaning prior to a T-piece SBT | |
Blumhof et al. [69] | A DTF > 20% is a robust predictor of extubation success during pressure support ventilation tests with 5/5 and 10/5 cmH2O with sensitivity and specificity values of 84.6% and 79.0%, 88.9% and 75.0%, respectively | |
DiNino et al. [70] | The authors find that a DTF threshold > 30% at end inspiration has a positive predictive value of 91% and a negative predictive value of 63% for extubation success (sensitivity 88% and specificity 91%, respectively), with similar results during both SBT and pressure support tests | |
Diaphragm excursion (DE) and diaphragm thickening fraction (DTF) | Farghaly et al. [71] | The authors found that cut-off values of DE ≥ 10.5 mm, Te-insp ≥ 21 mm, and DTF > 34.2% during SBT with pressure support were associated with successful weaning; combining a DE ≥ 10.5 mm with a Te-insp. ≥ 21 mm decreased the sensitivity to 64.9%, but increased specificity up to 100% for successful weaning |
Zambon et al. [72] | The authors describe both DE and DTF to be useful weaning predictors, but only DTF is shown to be an accurate index of diaphragmatic contractility workload | |
Llamas-Alvarez et al. [73] | This systematic review and metanalysis concludes that diaphragm ultrasound measures (DTF > DE) can help predict weaning outcome. It also suggests that the accuracy of DTF and DE may be overestimated in the current literature depending on the patient subpopulation studied | |
Vivier et al. [53] | The authors conducted a multicenter prospective study involving 191 patients where DTF and DE data were collected during T-piece SBTs. They found that diaphragmatic dysfunction as assessed by ultrasound (described as DE < 10 mm and DTF < 30%) was not associated with extubation failure |