Diaphragm function and weaning from mechanical ventilation: an ultrasound and phrenic nerve stimulation clinical study View Full Text


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Article Info

DATE

2018-04-23

AUTHORS

Martin Dres, Ewan C. Goligher, Bruno-Pierre Dubé, Elise Morawiec, Laurence Dangers, Danielle Reuter, Julien Mayaux, Thomas Similowski, Alexandre Demoule

ABSTRACT

BackgroundDiaphragm dysfunction is defined by a value of twitch tracheal pressure in response to magnetic phrenic stimulation (twitch pressure) amounting to less than 11 cmH2O. This study assessed whether this threshold or a lower one would predict accurately weaning failure from mechanical ventilation. Twitch pressure was compared to ultrasound measurement of diaphragm function.MethodsIn patients undergoing a first spontaneous breathing trial, diaphragm function was evaluated by twitch pressure and by diaphragm ultrasound (thickening fraction). Receiver operating characteristics curves were computed to determine the best thresholds predicting failure of spontaneous breathing trial.ResultsSeventy-six patients were evaluated, 48 (63%) succeeded and 28 (37%) failed the spontaneous breathing trial. The optimal thresholds of twitch pressure and thickening fraction to predict failure of the spontaneous breathing trial were, respectively, 7.2 cmH2O and 25.8%, respectively. The receiver operating characteristics curves were 0.80 (95% CI 0.70–0.89) for twitch pressure and 0.82 (95% CI 0.73–0.93) for thickening fraction. Both receiver operating characteristics curves were similar (p = 0.83). A twitch pressure value lower than 11 cmH2O (the traditional cutoff for diaphragm dysfunction) predicted failure of the spontaneous breathing trial with a sensitivity of 89% (95% CI 72–98%) and a specificity of 45% (95% CI 30–60%).ConclusionsFailure of spontaneous breathing trial can be predicted with a lower value of twitch pressure than the value defining diaphragm dysfunction. Twitch pressure and thickening fraction had similar strong performance in the prediction of failure of the spontaneous breathing trial. More... »

PAGES

53

References to SciGraph publications

  • 2016-03-07. Ultrasonography evaluation during the weaning process: the heart, the diaphragm, the pleura and the lung in INTENSIVE CARE MEDICINE
  • 2015-11-16. Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure in INTENSIVE CARE MEDICINE
  • 2016-07-15. Change in Diaphragmatic Thickness During the Respiratory Cycle Predicts Extubation Success at Various Levels of Pressure Support Ventilation in LUNG
  • 2016-07-31. Respiratory weakness after mechanical ventilation is associated with one-year mortality - a prospective study in CRITICAL CARE
  • 2013-06-20. Diaphragm weakness in mechanically ventilated critically ill patients in CRITICAL CARE
  • 2018-03-20. Diaphragm dysfunction during weaning from mechanical ventilation: an underestimated phenomenon with clinical implications in CRITICAL CARE
  • 2017-09-15. Critical illness-associated diaphragm weakness in INTENSIVE CARE MEDICINE
  • 2014-06-07. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation in THE ULTRASOUND JOURNAL
  • 2016-03-21. Diaphragm abnormalities in heart failure and aging: mechanisms and integration of cardiovascular and respiratory pathophysiology in HEART FAILURE REVIEWS
  • 2010-07-01. Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study in CRITICAL CARE
  • 2016-09-12. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review in INTENSIVE CARE MEDICINE
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    URI

    http://scigraph.springernature.com/pub.10.1186/s13613-018-0401-y

    DOI

    http://dx.doi.org/10.1186/s13613-018-0401-y

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/29687276


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    17 schema:description BackgroundDiaphragm dysfunction is defined by a value of twitch tracheal pressure in response to magnetic phrenic stimulation (twitch pressure) amounting to less than 11 cmH2O. This study assessed whether this threshold or a lower one would predict accurately weaning failure from mechanical ventilation. Twitch pressure was compared to ultrasound measurement of diaphragm function.MethodsIn patients undergoing a first spontaneous breathing trial, diaphragm function was evaluated by twitch pressure and by diaphragm ultrasound (thickening fraction). Receiver operating characteristics curves were computed to determine the best thresholds predicting failure of spontaneous breathing trial.ResultsSeventy-six patients were evaluated, 48 (63%) succeeded and 28 (37%) failed the spontaneous breathing trial. The optimal thresholds of twitch pressure and thickening fraction to predict failure of the spontaneous breathing trial were, respectively, 7.2 cmH2O and 25.8%, respectively. The receiver operating characteristics curves were 0.80 (95% CI 0.70–0.89) for twitch pressure and 0.82 (95% CI 0.73–0.93) for thickening fraction. Both receiver operating characteristics curves were similar (p = 0.83). A twitch pressure value lower than 11 cmH2O (the traditional cutoff for diaphragm dysfunction) predicted failure of the spontaneous breathing trial with a sensitivity of 89% (95% CI 72–98%) and a specificity of 45% (95% CI 30–60%).ConclusionsFailure of spontaneous breathing trial can be predicted with a lower value of twitch pressure than the value defining diaphragm dysfunction. Twitch pressure and thickening fraction had similar strong performance in the prediction of failure of the spontaneous breathing trial.
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    23 schema:keywords ConclusionsFailure
    24 MethodsIn patients
    25 ResultsSeventy-six patients
    26 breathing trial
    27 characteristic curve
    28 clinical studies
    29 curves
    30 diaphragm dysfunction
    31 diaphragm function
    32 diaphragm ultrasound
    33 dysfunction
    34 failure
    35 first spontaneous breathing trial
    36 fraction
    37 function
    38 lower values
    39 measurements
    40 mechanical ventilation
    41 patients
    42 performance
    43 phrenic stimulation
    44 prediction
    45 prediction of failure
    46 pressure
    47 pressure values
    48 receiver
    49 response
    50 sensitivity
    51 specificity
    52 spontaneous breathing trial
    53 stimulation
    54 strong performance
    55 study
    56 threshold
    57 tracheal pressure
    58 trials
    59 twitch pressure
    60 ultrasound
    61 values
    62 ventilation
    63 schema:name Diaphragm function and weaning from mechanical ventilation: an ultrasound and phrenic nerve stimulation clinical study
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