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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.

Author information

1
Hôpital Saint Joseph Saint Luc, Réanimation Polyvalente, Lyon, France. Electronic address: evivier@ch-stjoseph-stluc-lyon.fr.
2
Centre Hospitalier Annecy Genevoix, Réanimation Polyvalente, Metz-Tessy, France.
3
Hôpital Saint Joseph Saint Luc, Réanimation Polyvalente, Lyon, France.
4
CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France; INSERM CIC 1402 ALIVE, Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France.
5
INSERM (Dr Dessap), Unité U955, Créteil, France.

Abstract

BACKGROUND:

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

OBJECTIVE:

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

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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

KEYWORDS:

diaphragm; ultrasound; weaning

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