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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,036

Periodicità: Mensile

ISSN 0375-9393

Online ISSN 1827-1596


Minerva Anestesiologica 2016 Jul 12

Diaphragmatic ultrasonography as an adjunct predictor tool of weaning success in patients with difficult and prolonged weaning

Aikaterini FLEVARI, Michael LIGNOS, Dimitrios KONSTANTONIS, Apostolos ARMAGANIDIS

2nd University Critical Care Clinic, Attikon University Hospital, Athens, Greece

BACKGROUNG: Diaphagmatic ultrasonography has been recently considered as a new weaning predictor method. Previous studies checked diaphragmatic excursion and thickness during quiet or deep breathing in unselected populations of critically ill patients. Our study aims to investigate diaphragmatic excursion during quiet and unassisted breathing, in comparison to standard predictor tools, such as Rapid Shallow Breathing Index (RSBI) and Maximal Inspiratory Pressure (Pimax), in patients with difficult and/ or prolonged weaning.
METHODS: Patients with difficult and/or prolonged weaning, who met the criteria for spontaneous breathing trial were assessed. The excursion of each hemidiaphragm (DEx) was evaluated by B-mode and M-mode ultrasonography while patient was on quiet breathing and at supine position. RSBI and Pimax were simultaneously recorded and weaning outcome was recorded.
RESULTS: Thirteen male and fourteen female patients were included. DEx [median and interquartile range, mm] was 14 (8.5-22) for the right hemidiaphragm (RDEx) and 12 (7-23) for the left (LDEx). We found no difference in DEx between sexes. Among the four weaning predictor tools, LDEx at a cut-off 10mm was the best index to predict weaning success (sensitivity 86%, specificity 85%, Negative Predictive Value 94%). The optimal cut-off values, as determined by the area under the receiver operating characteristic curve, were 10mm for RDEx, 7mm for LDEx, 57breaths/min/L for RSBI and -20cmH2O for Pimax.
CONCLUSIONS: Our results suggest that DEx threshold of 10mm and 7mm for right and left hemidiaphragms respectively could be used as adjunct tool in the predictive algorithm of weaning in difficult to wean patients.

lingua: Inglese


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