Ability of parasternal intercostal muscle thickening fraction to predict reintubation in surgical patients with sepsis.
Diaphragmatic excursion
Failed weaning
Mechanical ventilation
Parasternal thickening
Reintubation
Spontaneous breathing trial
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
22 Aug 2024
22 Aug 2024
Historique:
received:
15
04
2024
accepted:
31
07
2024
medline:
23
8
2024
pubmed:
23
8
2024
entrez:
22
8
2024
Statut:
epublish
Résumé
We aimed to evaluate the ability of the parasternal intercostal (PIC) thickening fraction during spontaneous breathing trial (SBT) to predict the need for reintubation within 48 h after extubation in surgical patients with sepsis. This prospective observational study included adult patients with sepsis who were mechanically ventilated and indicated for SBT. Ultrasound measurements of the PIC thickening fraction and diaphragmatic excursion (DE) were recorded 15 min after the start of the SBT. After extubation, the patients were followed up for 48 h for the need for reintubation. The study outcomes were the ability of the PIC thickening fraction (primary outcome) and DE to predict reintubation within 48 h of extubation using area under receiver characteristic curve (AUC) analysis. The accuracy of the model including the findings of right PIC thickening fraction and right DE was also assessed using the current study cut-off values. Multivariate analysis was performed to identify independent risk factors for reintubation. We analyzed data from 49 patients who underwent successful SBT, and 10/49 (20%) required reintubation. The AUCs (95% confidence interval [CI]) for the ability of right and left side PIC thickening fraction to predict reintubation were 0.97 (0.88-1.00) and 0.96 (0.86-1.00), respectively; at a cutoff value of 6.5-8.3%, the PIC thickening fraction had a negative predictive value of 100%. The AUCs for the PIC thickening fraction and DE were comparable; and both measures were independent risk factors for reintubation. The AUC (95% CI) of the model including the right PIC thickening fraction > 6.5% and right DE ≤ 18 mm to predict reintubation was 0.99 (0.92-1.00), with a positive predictive value of 100% when both sonographic findings are positive and negative predictive value of 100% when both sonographic findings are negative. Among surgical patients with sepsis, PIC thickening fraction evaluated during the SBT is an independent risk factor for reintubation. The PIC thickening fraction has an excellent predictive value for reintubation. A PIC thickening fraction of ≤ 6.5-8.3% can exclude reintubation, with a negative predictive value of 100%. Furthermore, a combination of high PIC and low DE can also indicate a high risk of reintubation. However, larger studies that include different populations are required to replicate our findings and validate the cutoff values.
Identifiants
pubmed: 39174907
doi: 10.1186/s12871-024-02666-8
pii: 10.1186/s12871-024-02666-8
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
294Informations de copyright
© 2024. The Author(s).
Références
Anzueto A, Frutos F, Brochard L, Stewart TE, Benito S, Epstein SK, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation. JAMA. 2002;287:345–55.
doi: 10.1001/jama.287.3.345
pubmed: 11790214
Zilberberg MD, de Wit M, Pirone JR, Shorr AF. Growth in adult prolonged acute mechanical ventilation: implications for healthcare delivery. Crit Care Med. 2008;36:1451–5.
doi: 10.1097/CCM.0b013e3181691a49
pubmed: 18434911
Torres A, Gatell JM, Aznar E, El-ebiary M, Puig J, Bellacasa DELA, et al. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. AM J RESPIR CRIT CARE MED. 1995;152:137–41.
doi: 10.1164/ajrccm.152.1.7599812
pubmed: 7599812
Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med. 1998;158:489–93.
doi: 10.1164/ajrccm.158.2.9711045
pubmed: 9700126
McConville JF, Kress JP. Weaning patients from the Ventilator. N Engl J Med. 2012;367:2233–9.
doi: 10.1056/NEJMra1203367
pubmed: 23215559
Tuinman PR, Jonkman AH, Dres M, Shi ZH, 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. https://doi.org/10.1007/s00134-019-05892-8 .
doi: 10.1007/s00134-019-05892-8
pubmed: 32338308
pmcid: 7103016
Dres M, Dubé BP, Goligher E, Vorona S, Demiri S, Morawiec E, et al. Usefulness of Parasternal Intercostal Muscle Ultrasound during Weaning from Mechanical Ventilation. Anesthesiology. 2020;132:1114–25.
doi: 10.1097/ALN.0000000000003191
pubmed: 32084029
Helmy MA, Milad LM, Hasanin AM, Mostafa M, Mannaa AH, Youssef MM, et al. Parasternal intercostal thickening at hospital admission: a promising indicator for mechanical ventilation risk in subjects with severe COVID 19. J Clin Monit Comput. 2023. https://doi.org/10.1007/s10877-023-00989-4 .
doi: 10.1007/s10877-023-00989-4
pubmed: 36961635
pmcid: 10037364
He G, Han Y, Zhan Y, Yao Y, Zhou H, Zheng X. The combined use of parasternal intercostal muscle thickening fraction and P0.1 for prediction of weaning outcomes. Heart Lung. 2023;62:122–8.
doi: 10.1016/j.hrtlng.2023.07.002
pubmed: 37480723
Oliveira TS, Santos AT, Andrade CBV, Silva JD, Blanco N, de Rocha N. Sepsis disrupts mitochondrial function and diaphragm morphology. Front Physiol. 2021;12:704044.
doi: 10.3389/fphys.2021.704044
pubmed: 34557108
pmcid: 8452856
Chen Y, Liu Y, Han M, Zhao S, Tan Y, Hao L, et al. Quantification of diaphragmatic dynamic dysfunction in septic patients by bedside ultrasound. Sci Rep. 2022;12:17336.
doi: 10.1038/s41598-022-21702-6
pubmed: 36243883
pmcid: 9569367
Jung B, Nougaret S, Conseil M, Coisel Y, Futier E, Chanques G, et al. Sepsis is Associated with a preferential diaphragmatic atrophy: a critically ill patient study using Tridimensional Computed Tomography. Anesthesiology. 2014;120:1182–91.
doi: 10.1097/ALN.0000000000000201
pubmed: 24608360
Dres M, Goligher EC, Heunks LMA, Brochard LJ. Critical illness associated diaphragm weakness. Intensive Care Med. 2017;43:1441–52.
doi: 10.1007/s00134-017-4928-4
pubmed: 28917004
Petrof BJ. Diaphragmatic dysfunction in the intensive care unit: Caught in the cross-fire between sepsis and mechanical ventilation. Crit Care. 2013;17.
Opal SM, Rubenfeld GD, Poll T, Van Der, Vincent J, Angus DC. The Third International Consensus definitions for Sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801–10.
doi: 10.1001/jama.2016.0287
pubmed: 26903338
pmcid: 4968574
Peñuelas Ó, Thille AW, Esteban A. Discontinuation of ventilatory support: new solutions to old dilemmas. Curr Opin Crit Care. 2015;21:74–81.
doi: 10.1097/MCC.0000000000000169
pubmed: 25546535
Schmidt M, Kindler F, Gottfried SB, Raux M, Hug F, Similowski T, et al. Dyspnea and surface inspiratory electromyograms in mechanically ventilated patients. Intensive Care Med. 2013;39:1368–76.
doi: 10.1007/s00134-013-2910-3
pubmed: 23575612
Formenti P, Umbrello M, Dres M, Chiumello D. Ultrasonographic assessment of parasternal intercostal muscles during mechanical ventilation. Ann Intensiv Care. 2020;10.
Paolo F, Valentina DG, Silvia C, Tommaso P, Elena C, Martin D et al. The possible predictive value of muscle ultrasound in the diagnosis of ICUAW in long-term critically ill patients. J Crit Care. 2022;71.
Helmy MA, Hasanin A, Milad LM, Mostafa M, Fathy S. Parasternal intercostal muscle thickening as a predictor of non-invasive ventilation failure in patients with COVID-19. Anaesth Crit Care Pain Med. 2022;41:101063.
doi: 10.1016/j.accpm.2022.101063
pubmed: 35487407
pmcid: 9040441
Elmer J, Lee S, Rittenberger JC, Dargin J, Winger D, Emlet L. Reintubation in critically ill patients: procedural complications and implications for care. Crit Care. 2015;19:12.
doi: 10.1186/s13054-014-0730-7
pubmed: 25592172
pmcid: 4328699
Thille AW, Harrois A, Schortgen F, Brun-Buisson C, Brochard L. Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med. 2011;39:2612–8.
doi: 10.1097/CCM.0b013e3182282a5a
pubmed: 21765357
Frutos-Vivar F, Esteban A, Apezteguia C, González M, Arabi Y, Restrepo MI, et al. Outcome of reintubated patients after scheduled extubation. J Crit Care. 2011;26:502–9.
doi: 10.1016/j.jcrc.2010.12.015
pubmed: 21376523
Chen Y, Liu Y, Han M, Zhao S, Tan Y, Hao L, et al. Quantification of diaphragmatic dynamic dysfunction in septic patients by bedside ultrasound. Sci Rep. 2022;12:1–8.
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. 2022;26:1–9.
doi: 10.1186/s13054-022-03975-5
Vetrugno L, Orso D, Corradi F, Zani G, Spadaro S, Meroi F, et al. Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study. Respir Res. 2022;23:1–7.
doi: 10.1186/s12931-022-02138-y
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;20:1–11.
doi: 10.1186/s13054-016-1479-y
pubmed: 26728475
pmcid: 4700777
You A, It L. Tracheal reintubation: caused by too much of a good thing ? Respir Care. 2012;57:1687–91.
doi: 10.4187/respcare.02082
Hernández G, Paredes I, Moran F, Buj M, Colinas L, Rodríguez ML, et al. Effect of postextubation noninvasive ventilation with active humidification vs high-flow nasal cannula on reintubation in patients at very high risk for extubation failure: a randomized trial. Intensive Care Med. 2022;48:1751–9.
doi: 10.1007/s00134-022-06919-3
pubmed: 36400984
pmcid: 9676812
Hernández G, Vaquero C, González P, Subira C, Frutos-Vivar F, Rialp G, et al. Effect of Postextubation High-Flow nasal cannula vs conventional oxygen therapy on Reintubation in Low-Risk patients: a Randomized Clinical Trial. JAMA. 2016;315:1354–61.
doi: 10.1001/jama.2016.2711
pubmed: 26975498
Thille AW, Muller G, Gacouin A, Coudroy R, Decavèle M, Sonneville R, et al. Effect of Postextubation High-Flow Nasal Oxygen with Noninvasive Ventilation vs High-Flow nasal oxygen alone on Reintubation among patients at high risk of Extubation failure: a Randomized Clinical Trial. JAMA. 2019;322:1465–75.
doi: 10.1001/jama.2019.14901
pubmed: 31577036
pmcid: 6802261
Casey JD, Vaughan EM, Lloyd BD, Billas PA, Jackson KE, Hall EJ, et al. Protocolized Postextubation respiratory support to prevent Reintubation: a Randomized Clinical Trial. Am J Respir Crit Care Med. 2021;204:294–302.
doi: 10.1164/rccm.202009-3561OC
pubmed: 33794131
pmcid: 8513595
Hernández G, Vaquero C, Ortiz R, Colinas L, de Pablo R, Segovia L, et al. Benefit with preventive noninvasive ventilation in subgroups of patients at high-risk for reintubation: a post hoc analysis. J Intensive Care. 2022;10:43.
doi: 10.1186/s40560-022-00635-2
pubmed: 36089625
pmcid: 9465935
Vieillard-Baron A, Millington SJ, Sanfilippo F, Chew M, Diaz-Gomez J, McLean A, et al. A decade of progress in critical care echocardiography: a narrative review. Intensive Care Med. 2019;45:770–88.
doi: 10.1007/s00134-019-05604-2
pubmed: 30911808
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
Atkinson P, Bowra J, Lambert M, Lamprecht H, Noble V, Jarman B. International Federation for Emergency Medicine point of care ultrasound curriculum. CJEM. 2015;17:161–70.
doi: 10.1017/cem.2015.8
pubmed: 26052968