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Chest. 2019 Jun;155(6):1131-1139. doi: 10.1016/j.chest.2019.03.004. Epub 2019 Mar 23.

Inability of Diaphragm Ultrasound to Predict Extubation Failure: A Multicenter Study.

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Hôpital Saint Joseph Saint Luc, Réanimation Polyvalente, Lyon, France. Electronic address:
Centre Hospitalier Annecy Genevoix, Réanimation Polyvalente, Metz-Tessy, France.
Hôpital Saint Joseph Saint Luc, Réanimation Polyvalente, Lyon, France.
CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France; INSERM CIC 1402 ALIVE, Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France.
INSERM (Dr Dessap), Unité U955, Créteil, France.



Diaphragmatic dysfunction may promote weaning difficulties in patients who are mechanically ventilated.


The goal of this study was to assess whether diaphragm dysfunction detected by ultrasound prior to extubation could predict extubation failure in the ICU.


This multicenter prospective study included patients at high risk of reintubation: those aged > 65 years, with underlying cardiac or respiratory disease, or intubated > 7 days. All patients had successfully undergone a spontaneous breathing trial. Diaphragmatic function was assessed by ultrasound prior to extubation while breathing spontaneously on a T-piece. Bilateral diaphragmatic excursion and apposition thickening fraction were measured, and diaphragmatic dysfunction was defined as excursion < 10 mm or thickening < 30%. Cough strength was clinically assessed by physiotherapists. Extubation failure was defined as reintubation or death within the 7 days following extubation.


Over a 20-month period, 191 at-risk patients were studied. Among them, 33 (17%) were considered extubation failures. The proportion of patients with diaphragmatic dysfunction was similar between those whose extubation succeeded and those whose extubation failed: 46% vs 51% using excursion (P = .55), and 71% vs 68% using thickening (P = .73), respectively. Values of excursion and thickening did not differ between the success and the failure groups: at right, excursion was 14 ± 7 mm vs 11 ± 8 (P = .13), and thickening was 29 ± 29% vs 38 ± 48% (P = .83), respectively. Extubation failure rates were 7%, 22%, and 46% in patients with effective, moderate, and ineffective cough (P < .01). Ineffective cough was the only variable independently associated with extubation failure.


Diaphragmatic dysfunction assessed by ultrasound was not associated with an increased risk of extubation failure.


diaphragm; ultrasound; weaning

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