Operator independent continuous ultrasound monitoring of diaphragm excursion predicts successful weaning from mechanical ventilation: a prospective observational study.
Diaphragm
Mechanical ventilation
Ultrasound
Weaning
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
16 Jul 2024
16 Jul 2024
Historique:
received:
27
03
2024
accepted:
24
06
2024
medline:
17
7
2024
pubmed:
17
7
2024
entrez:
16
7
2024
Statut:
epublish
Résumé
In mechanically ventilated patients, diaphragm ultrasound can identify diaphragm weakness and predict weaning failure. We evaluated whether a novel operator-independent ultrasound-based medical device allowing continuous monitoring of the diaphragm (CUSdi) could reliably (1) measure diaphragm excursion (EXdi) and peak contraction velocity (PCVdi), (2) predict weaning outcome, and (3) approximate transdiaphragmatic pressure (Pdi). In 49 mechanically ventilated patients, CUSdi was recorded during a 30-min spontaneous breathing trial (SBT), and EXdi and PCVdi were measured. In subgroups of patients, standard ultrasound measurement of EXdi and PCVdi was performed (n = 36), and Pdi derived parameters (peak and pressure time product, n = 30) were measured simultaneously. The agreement bias between standard ultrasound and CUSdi for EXdi was 0.1 cm (95% confidence interval -0.7-0.9 cm). The regression of Passing-Bablok indicated a lack of systematic difference between EXdi measured with standard ultrasound and CUSdi, which were positively correlated (Rho = 0.84, p < 0.001). Weaning failure was observed in 54% of patients. One, two and three minutes after the onset of the SBT, EXdi was higher in the weaning success group than in the failure group. Two minutes after the onset of the SBT, an EXdi < 1.1 cm predicted weaning failure with a sensitivity of 0.83, a specificity of 0.68, a positive predictive value of 0.76, and a negative predictive value of 0.24. There was a weak correlation between EXdi and both peak Pdi (r = 0.22, 95% confidence interval 0.15 - 0.28) and pressure time product (r = 0.13, 95% confidence interval 0.06 - 0.20). Similar results were observed with PCVdi. Operator-independent continuous diaphragm monitoring quantifies EXdi reliably and can predict weaning failure with an identified cut-off value of 1.1 cm. Trial registration clinicaltrial.gov, NCT04008875 (submitted 12 April 2019, posted 5 July 2019) and NCT03896048 (submitted 27 March 2019, posted 29 March 2019).
Sections du résumé
BACKGROUND
BACKGROUND
In mechanically ventilated patients, diaphragm ultrasound can identify diaphragm weakness and predict weaning failure. We evaluated whether a novel operator-independent ultrasound-based medical device allowing continuous monitoring of the diaphragm (CUSdi) could reliably (1) measure diaphragm excursion (EXdi) and peak contraction velocity (PCVdi), (2) predict weaning outcome, and (3) approximate transdiaphragmatic pressure (Pdi).
METHODS
METHODS
In 49 mechanically ventilated patients, CUSdi was recorded during a 30-min spontaneous breathing trial (SBT), and EXdi and PCVdi were measured. In subgroups of patients, standard ultrasound measurement of EXdi and PCVdi was performed (n = 36), and Pdi derived parameters (peak and pressure time product, n = 30) were measured simultaneously.
RESULTS
RESULTS
The agreement bias between standard ultrasound and CUSdi for EXdi was 0.1 cm (95% confidence interval -0.7-0.9 cm). The regression of Passing-Bablok indicated a lack of systematic difference between EXdi measured with standard ultrasound and CUSdi, which were positively correlated (Rho = 0.84, p < 0.001). Weaning failure was observed in 54% of patients. One, two and three minutes after the onset of the SBT, EXdi was higher in the weaning success group than in the failure group. Two minutes after the onset of the SBT, an EXdi < 1.1 cm predicted weaning failure with a sensitivity of 0.83, a specificity of 0.68, a positive predictive value of 0.76, and a negative predictive value of 0.24. There was a weak correlation between EXdi and both peak Pdi (r = 0.22, 95% confidence interval 0.15 - 0.28) and pressure time product (r = 0.13, 95% confidence interval 0.06 - 0.20). Similar results were observed with PCVdi.
CONCLUSIONS
CONCLUSIONS
Operator-independent continuous diaphragm monitoring quantifies EXdi reliably and can predict weaning failure with an identified cut-off value of 1.1 cm. Trial registration clinicaltrial.gov, NCT04008875 (submitted 12 April 2019, posted 5 July 2019) and NCT03896048 (submitted 27 March 2019, posted 29 March 2019).
Identifiants
pubmed: 39014512
doi: 10.1186/s13054-024-05003-0
pii: 10.1186/s13054-024-05003-0
doi:
Banques de données
ClinicalTrials.gov
['NCT04008875', 'NCT03896048', 'NCT04008875']
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
245Informations de copyright
© 2024. The Author(s).
Références
Dres M, Demoule A. Diaphragm dysfunction during weaning from mechanical ventilation: an underestimated phenomenon with clinical implications. Crit Care Lond Engl. 2018;22:73.
doi: 10.1186/s13054-018-1992-2
Demoule A, Jung B, Prodanovic H, Molinari N, Chanques G, Coirault C, et al. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-a prospective study. Am J Respir Crit Care Med. 2013;188:213–9.
doi: 10.1164/rccm.201209-1668OC
pubmed: 23641946
Dres M, Dubé B-P, Mayaux J, Delemazure J, Reuter D, Brochard L, et al. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients. Am J Respir Crit Care Med. 2017;195:57–66.
doi: 10.1164/rccm.201602-0367OC
pubmed: 27310484
Laveneziana P, Albuquerque A, Aliverti A, Babb T, Barreiro E, Dres M, et al. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J. 2019. https://doi.org/10.1183/13993003.01214-2018 .
doi: 10.1183/13993003.01214-2018
pubmed: 31857385
Watson AC, Hughes PD, Louise Harris M, Hart N, Ware RJ, Wendon J, et al. Measurement of twitch transdiaphragmatic, esophageal, and endotracheal tube pressure with bilateral anterolateral magnetic phrenic nerve stimulation in patients in the intensive care unit. Crit Care Med. 2001;29:1325–31.
doi: 10.1097/00003246-200107000-00005
pubmed: 11445679
Haaksma ME, Smit JM, Boussuges A, Demoule A, Dres M, Ferrari G, et al. EXpert consensus On Diaphragm UltraSonography in the critically ill (EXODUS): a Delphi consensus statement on the measurement of diaphragm ultrasound-derived parameters in a critical care setting. Crit Care Lond Engl. 2022;26:99.
doi: 10.1186/s13054-022-03975-5
Tuinman PR, Jonkman AH, Dres M, Shi Z-H, Goligher EC, Goffi A, et al. Respiratory muscle ultrasonography: methodology, basic and advanced principles and clinical applications in ICU and ED patients-a narrative review. Intensive Care Med 2020;46:594–605.
DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax. 2014;69:423–7.
doi: 10.1136/thoraxjnl-2013-204111
pubmed: 24365607
Kim WY, Suh HJ, Hong S-B, Koh Y, Lim C-M. Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation. Crit Care Med. 2011;39:2627–30.
doi: 10.1097/CCM.0b013e3182266408
pubmed: 21705883
Robba C, Wong A, Poole D, Al Tayar A, Arntfield RT, Chew MS, et al. Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: consensus and expert recommendations of the European Society of Intensive Care Medicine. Intensive Care Med. 2021;47:1347–67.
doi: 10.1007/s00134-021-06486-z
pubmed: 34787687
pmcid: 8596353
Soilemezi E, Savvidou S, Sotiriou P, Smyrniotis D, Tsagourias M, Matamis D. Tissue doppler imaging of the diaphragm in healthy subjects and critically Ill patients. Am J Respir Crit Care Med. 2020;202:1005–12.
doi: 10.1164/rccm.201912-2341OC
pubmed: 32614246
pmcid: 7528801
Koski JM, Saarakkala S, Helle M, Hakulinen U, Heikkinen JO, Hermunen H, et al. Assessing the intra- and inter-reader reliability of dynamic ultrasound images in power Doppler ultrasonography. Ann Rheum Dis. 2006;65:1658–60.
doi: 10.1136/ard.2005.051250
pubmed: 16728459
pmcid: 1798451
Naqvi J, Yap KH, Ahmad G, Ghosh J. Transcranial Doppler ultrasound: a review of the physical principles and major applications in critical care. Int J Vasc Med. 2013;2013:629378.
pubmed: 24455270
pmcid: 3876587
Jiang J-R, Tsai T-H, Jerng J-S, Yu C-J, Wu H-D, Yang P-C. Ultrasonographic evaluation of liver/spleen movements and extubation outcome. Chest. 2004;126:179–85.
doi: 10.1016/S0012-3692(15)32912-3
pubmed: 15249460
Baydur A, Behrakis PK, Zin WA, Jaeger M, Milic-Emili J. A simple method for assessing the validity of the esophageal balloon technique. Am Rev Respir Dis. 1982;126:788–91.
pubmed: 7149443
Vaporidi K, Soundoulounaki S, Papadakis E, Akoumianaki E, Kondili E, Georgopoulos D. Esophageal and transdiaphragmatic pressure swings as indices of inspiratory effort. Respir Physiol Neurobiol. 2021;284:103561.
doi: 10.1016/j.resp.2020.103561
pubmed: 33035709
Subirà C, Hernández G, Vázquez A, Rodríguez-García R, González-Castro A, García C, et al. Effect of pressure support vs T-piece ventilation strategies during spontaneous breathing trials on successful extubation among patients receiving mechanical ventilation: a randomized clinical trial. JAMA. 2019;321:2175–82.
doi: 10.1001/jama.2019.7234
pubmed: 31184740
pmcid: 6563557
Thille AW, Gacouin A, Coudroy R, Ehrmann S, Quenot J-P, Nay M-A, et al. Spontaneous-breathing trials with pressure-support ventilation or a T-piece. N Engl J Med. 2022;387:1843–54.
doi: 10.1056/NEJMoa2209041
pubmed: 36286317
Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50:52683.
doi: 10.1183/13993003.02426-2016
Rochwerg B, Einav S, Chaudhuri D, Mancebo J, Mauri T, Helviz Y, et al. The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline. Intensive Care Med. 2020;46:2226–37.
doi: 10.1007/s00134-020-06312-y
pubmed: 33201321
pmcid: 7670292
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 Lond Engl. 2016;20:305.
doi: 10.1186/s13054-016-1479-y
Dres M, Goligher EC, Dubé B-P, Morawiec E, Dangers L, Reuter D, et al. Diaphragm function and weaning from mechanical ventilation: an ultrasound and phrenic nerve stimulation clinical study. Ann Intensive Care. 2018;8:53.
doi: 10.1186/s13613-018-0401-y
pubmed: 29687276
pmcid: 5913054
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet Lond Engl. 1986;1:307–10.
doi: 10.1016/S0140-6736(86)90837-8
Passing H, Bablok null. A new biometrical procedure for testing the equality of measurements from two different analytical methods. Application of linear regression procedures for method comparison studies in clinical chemistry, Part I. J Clin Chem Clin Biochem Z Klin Chem Klin Biochem 1983;21:709–720.
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45.
doi: 10.2307/2531595
pubmed: 3203132
Bakdash JZ, Marusich LR. Repeated measures correlation. Front Psychol. 2017;8:456.
doi: 10.3389/fpsyg.2017.00456
pubmed: 28439244
pmcid: 5383908
Testa A, Soldati G, Giannuzzi R, Berardi S, Portale G, Gentiloni SN. Ultrasound M-mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects. Ultrasound Med Biol. 2011;37:44–52.
doi: 10.1016/j.ultrasmedbio.2010.10.004
pubmed: 21144957
Soilemezi E, Tsagourias M, Talias MA, Soteriades ES, Makrakis V, Zakynthinos E, et al. Sonographic assessment of changes in diaphragmatic kinetics induced by inspiratory resistive loading. Respirol Carlton Vic. 2013;18:468–73.
doi: 10.1111/resp.12011
Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest. 2009;135:391–400.
doi: 10.1378/chest.08-1541
pubmed: 19017880
Matamis D, Soilemezi E, Tsagourias M, Akoumianaki E, Dimassi S, Boroli F, et al. Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications. Intensive Care Med 2013;39:801–810.
Dubé B-P, 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;72:811–8.
doi: 10.1136/thoraxjnl-2016-209459
pubmed: 28360224
Sklar MC, Burns K, Rittayamai N, Lanys A, Rauseo M, Chen L, et al. Effort to Breathe with Various Spontaneous Breathing Trial Techniques. A Physiologic Meta-analysis. Am J Respir Crit Care Med 2017;195:1477–1485.
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 Lond Engl. 2015;19:161.
doi: 10.1186/s13054-015-0894-9
McConville JF, Kress JP. Weaning patients from the ventilator. N Engl J Med. 2012;367:2233–9.
doi: 10.1056/NEJMra1203367
pubmed: 23215559
Dres M, Jung B, Molinari N, Manna F, Dubé B-P, Chanques G, et al. Respective contribution of intensive care unit-acquired limb muscle and severe diaphragm weakness on weaning outcome and mortality: a post hoc analysis of two cohorts. Crit Care Lond Engl. 2019;23:370.
doi: 10.1186/s13054-019-2650-z
Jung B, Moury PH, Mahul M, de Jong A, Galia F, Prades A, et al. Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure. Intensive Care Med. 2016;42:853–61.
doi: 10.1007/s00134-015-4125-2
pubmed: 26572511
Parada-Gereda HM, Tibaduiza AL, Rico-Mendoza A, Molano-Franco D, Nieto VH, Arias-Ortiz WA, et al. Effectiveness of diaphragmatic ultrasound as a predictor of successful weaning from mechanical ventilation: a systematic review and meta-analysis. Crit Care Lond Engl. 2023;27:174.
doi: 10.1186/s13054-023-04430-9
Fossat G, Daillet B, Desmalles E, Boulain T. Does diaphragm ultrasound improve the rapid shallow breathing index accuracy for predicting the success of weaning from mechanical ventilation? Aust Crit Care Off J Confed Aust Crit Care Nurses. 2022;35:233–40.