Diaphragmatic Dynamics and Thickness Parameters Assessed by Ultrasonography Predict Extubation Success in Critically Ill Patients.
INTRODUCTION: A frequent cause of weaning and extubation failure in critically ill mechanically ventilated patients is diaphragm muscle dysfunction. Ultrasound (US) evaluation of the diaphragm yields important data regarding its thickness (diaphragm thickening fraction [TFdi]) and its movement or ex...
| Published in: | Clinical Medicine Insights: Circulatory, Respiratory & Pulmonary Medicine pp. 1 - 9 |
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| Main Authors: | , , , , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Sage Publications Inc.
3/27/2023
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=162731501&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 162731501 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 11795484 B3KN jtl: Clinical Medicine Insights: Circulatory, Respiratory & Pulmonary Medicine issn: 11795484 maglogo: Y pubinfo: dt: 3/27/2023 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 162731501 162731501 162731501 10.1177/11795484231165940 162731501 ppf: 1 ppct: 8 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Diaphragmatic Dynamics and Thickness Parameters Assessed by Ultrasonography Predict Extubation Success in Critically Ill Patients. aug: au: Laguado-Nieto, Marlon Adrián Roberto-Avilán, Sandra Liliana Naranjo-Junoy, Francisco Meléndez-Flórez, Héctor Julio Lozada-Martinez, Ivan David Domínguez-Alvarado, Gonzalo Andrés Campos-Castillo, Víctor Alfonso Ríos-Orozco, Sergio Uriel Narváez-Rojas, Alexis Rafael affil: Department of Critical Medicine and Intensive Care, FOSCAL International Clinic, Bucaramanga, Colombia sug: subj: Critically Ill Patients Respiration, Artificial Methods Extubation Evaluation Ultrasonography Methods Diaphragm Physiology Diaphragm Anatomy and Histology Human Cross Sectional Studies Prospective Studies Descriptive Statistics Data Analysis Software Confidence Intervals Odds Ratio Male Female Young Adult Adult Middle Age Aged Aged, 80 and Over Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: INTRODUCTION: A frequent cause of weaning and extubation failure in critically ill mechanically ventilated patients is diaphragm muscle dysfunction. Ultrasound (US) evaluation of the diaphragm yields important data regarding its thickness (diaphragm thickening fraction [TFdi]) and its movement or excursion (diaphragmatic dynamics) that reveal the presence of diaphragmatic dysfunction. METHODS: Cross-sectional study, which included patients older than 18 years with invasive mechanical ventilation with an expected duration of more than 48 h, in a tertiary referral center in Colombia. The excursion of the diaphragm, inspiratory and expiratory thickness, and TFdi were evaluated by US. Prevalence and use of medications were evaluated, and the association with failure in ventilatory weaning and extubation was analyzed. RESULTS: Sixty-one patients were included. The median age and APACHE IV score were 62.42 years and 78.23, respectively. The prevalence of diaphragmatic dysfunction (assessed by excursion and TFdi) was 40.98%. The sensibility, specificity, positive predictive value, and negative predictive value for TFdi < 20% was 86%, 24%, 75%, and 40%, respectively, with an area under the receiver operating characteristic (ROC) curve of 0.6. The ultrasonographic analysis of excursion of the diaphragm, inspiratory and expiratory thickness, and TFdi (>20%) allow in its set and with normal values, predict success or failure for the extubation with an area under the ROC curve of 0.87. CONCLUSION: Diaphragmatic dynamics and thickness parameters together assessed by ultrasonography could predict the success of extubation in critically ill patients in Colombia, based on the finding of diaphragmatic dysfunction. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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