The Relationship of Diaphragmatic Ultrasound-Based and Manometric Indices With Difficult Weaning in Tracheostomized Patients.
BACKGROUND: Patients with a tracheostomy and difficult weaning from invasive mechanical ventilation constitute a challenging problem in critical care. An increased duration of ventilation may lead to diaphragmatic dysfunction and a noninvasive assessment of the diaphragm, such as ultrasound, attract...
| Publicado en: | Respiratory Care Vol. 69; no. 10; pp. 1323 - 1332 |
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| Autores principales: | , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Oct2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=180048440&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 180048440 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Oct2024 vid: 69 iid: 10 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 180048440 180048440 180048440 10.4187/respcare.11782 180048440 ppf: 1323 ppct: 9 formats: fmt: @attributes: type: P tig: atl: The Relationship of Diaphragmatic Ultrasound-Based and Manometric Indices With Difficult Weaning in Tracheostomized Patients. aug: au: Menis, Apostolos-Alkiviadis Tsolaki, Vasiliki Papadonta, Maria-Eirini Vazgiourakis, Vasileios Mantzarlis, Kostantinos Zakynthinos, Epaminondas Makris, Demosthenes affil: Intensive Care Unit, University Hospital of Larissa, Larissa, Greece sug: subj: Manometry Diaphragm Ultrasonography Tracheostomy Ventilator Weaning Muscle Strength Human Prospective Studies Intensive Care Units Greece Diaphragm Physiology Esophagus Physiology Pressure (Physiology) Evaluation Respiratory Airflow Evaluation Respiration, Artificial Treatment Failure ROC Curve Nonexperimental Studies Youden's J Statistic Sampling Methods Software Signal Processing, Computer Assisted Ultrasonography Equipment and Supplies Intraclass Correlation Coefficient Confidence Intervals Descriptive Statistics T-Tests Mann-Whitney U Test Chi Square Test Pearson's Correlation Coefficient Sensitivity and Specificity Predictive Value of Tests Data Analysis Software Male Female Adult Middle Age Aged APACHE (Acute Physiology and Chronic Health Evaluation) Clinical Assessment Tools Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Male Female ab: BACKGROUND: Patients with a tracheostomy and difficult weaning from invasive mechanical ventilation constitute a challenging problem in critical care. An increased duration of ventilation may lead to diaphragmatic dysfunction and a noninvasive assessment of the diaphragm, such as ultrasound, attracts interest in the clinical practice. We evaluated the relationship of ultrasound-derived indices with weaning outcome and with established indices of respiratory strength and load in subjects who are tracheostomized and undergoing weaning. METHODS: This prospective study was conducted at an academic ICU in Greece. Twenty subjects with tracheostomy and difficult weaning, during a spontaneous breathing trial, underwent time synchronous diaphragmatic sonography and esophageal manometry, to assess diaphragmatic excursion and thickening fraction, esophageal and transdiaphragmatic pressures, pressure-time product of the esophageal pressure, and maximum inspiratory pressure. The primary outcome was liberation from mechanical ventilation at 48 h. The relationship of diaphragmatic ultrasound with esophageal pressure-derived indices was also evaluated. RESULTS: Weaning from invasive ventilation failed in 10 subjects. Diaphragmatic excursion exhibited a significant difference between weaning success and failure (1.34 ± 0.56 versus 0.79 ± 0.44; P = .044), a strong correlation with transdiaphragmatic pressure (r = 0.7, P = .02), and a moderate correlation with the pressure-time product of the esophageal pressure (r = 0.65, P = .02) and the maximum inspiratory pressure (r = 0.66, P = .02). Transdiaphragmatic pressure presented the highest area under the curve (0.97). However, when transdiaphragmatic pressure was compared with diaphragmatic excursion (area under the curve, 0.84) for predictive accuracy, no significant difference was found. CONCLUSIONS: Diaphragmatic excursion is a valuable tool for the assessment of diaphragmatic strength, respiratory load, and weaning prediction. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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