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Arch Bronconeumol. 2019 Apr;55(4):195-200. doi: 10.1016/j.arbres.2018.09.015. Epub 2018 Nov 14.

Pulmonary Ultrasound and Diaphragmatic Shortening Fraction Combined Analysis for Extubation-Failure-Prediction in Critical Care Patients.

[Article in English, Spanish]

Author information

1
Department of Pulmonary and Critical Care Medicine, "Dr. José E. González" University Hospital, Nuevo León Autonomous University, Monterrey, Mexico. Electronic address: jeglza111@gmail.com.
2
Department of Pulmonary and Critical Care Medicine, "Dr. José E. González" University Hospital, Nuevo León Autonomous University, Monterrey, Mexico.
3
Nuevo León Autonomous University, Monterrey, Mexico.

Abstract

INTRODUCTION:

Invasive respiratory support is a cornerstone of Critical Care Medicine, however, protocols for withdrawal of mechanical ventilation are still far from perfect. Failure to extubation occurs in up to 20% of patients, despite a successful spontaneous breathing trial (SBT).

METHODS:

We prospectively included ventilated patients admitted to medical and surgical intensive care unit in a university hospital in northern Mexico. At the end of a successful SBT, we measured diaphragmatic shortening fraction (DSF) by the formula: diaphragmatic thickness at the end of inspiration - diaphragmatic thickness at the end of expiration/diaphragmatic thickness at the end of expiration×100, and the presence of B-lines in five regions of the right and left lung. The primary objective was to determine whether analysis of DSF combined with pulmonary ultrasound improves prediction of extubation failure.

RESULTS:

Eighty-two patients were included, 24 (29.2%) failed to extubation. At univariate analysis, DSF (Youden's J: >30% [sensibility and specificity 62 and 50%, respectively]) and number of B-lines regions (Youden's J: >1 zone [sensibility and specificity 66 and 92%, respectively]) were significant related to extubation failure (area under the curve 0.66 [0.52-0.80] and 0.81 [0.70-0.93], respectively). At the binomial logistic regression, only the number of B-lines regions remains significantly related to extubation failure (OR 5.91 [2.33-14.98], P<.001).

CONCLUSION:

In patients with a successfully SBT, the absence of B-lines significantly decreases the probability of extubation failure. Diaphragmatic shortening fraction analysis does not add predictive power over the use of pulmonary ultrasound.

KEYWORDS:

Airway extubation; Artificial respiration; Critical care; Cuidados intensivos; Diagnostic imaging; Diagnóstico por imagen; Ecografía; Extubación de las vías aéreas; Respiración artificial; Ultrasonography

PMID:
30446249
DOI:
10.1016/j.arbres.2018.09.015
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