Point-of-Care Ultrasound Evaluation of Diaphragm as a Predictor of Extubation Success in Mechanically Ventilated, Malnourished, End-Stage Liver Disease Pretransplant Candidates—Observational Cohort Study.
Background: Ultrasound evaluation of diaphragmatic anatomy and function has recently gained traction as a simple and useful tool to assess the extubation readiness in mechanically ventilated patients, nevertheless, how applicable this approach is in the population of chronically debilitated patients...
| Publicado en: | Therapeutic Advances in Pulmonary & Critical Care Medicine pp. 1 - 16 |
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| Autores principales: | , , , , , , , , |
| Formato: | diagnostic images research tables/charts Journal Article |
| Publicado: |
Sage Publications Inc.
5/2/2025
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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=184910245&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 184910245 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 29768675 NKBK jtl: Therapeutic Advances in Pulmonary & Critical Care Medicine issn: 29768675 maglogo: N pubinfo: dt: 5/2/2025 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 184910245 184910245 184910245 10.1177/29768675251337833 184910245 ppf: 1 ppct: 15 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Point-of-Care Ultrasound Evaluation of Diaphragm as a Predictor of Extubation Success in Mechanically Ventilated, Malnourished, End-Stage Liver Disease Pretransplant Candidates—Observational Cohort Study. aug: au: Reid, Adam Muhammad Bhattacharyya, Sarathi Zhuang, Zian Qadir, Nida Schnabel, Amy Chiem, Alan Yoon, Semi Lim, George Barjaktarevic, Igor affil: Department of Internal Medicine, 6566 Jefferson Einstein Philadelphia Hospital, Philadelphia, Pennsylvania, USA sug: subj: Liver Failure Ultrasonography Diaphragm Ultrasonography Extubation Respiration, Artificial Malnutrition Prediction Models Point-of-Care Testing Human Male Female Adult Middle Age Prospective Studies Nonexperimental Studies Descriptive Statistics Time Factors Inspiration, Respiratory Evaluation Wilcoxon Rank Sum Test Chi Square Test Fisher's Exact Test ROC Curve Multiple Logistic Regression Linear Regression Confidence Intervals Nutritional Status Muscle Strength Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: Background: Ultrasound evaluation of diaphragmatic anatomy and function has recently gained traction as a simple and useful tool to assess the extubation readiness in mechanically ventilated patients, nevertheless, how applicable this approach is in the population of chronically debilitated patients on mechanical ventilation (MV) remains unclear. Objective: To evaluate ultrasonographic assessment of diaphragmatic thickening fraction (ΔTDI%) as a predictor of extubation success in the population of end-stage liver disease (ESLD) malnourished patients on MV. Design: Prospective, single-center, observational cohort study Methods: We used point-of-care ultrasound to evaluate ΔTDI% and diaphragm thickness during expiration (T exp) and inspiration (T insp) as predictors of extubation success in ESLD patients undergoing weaning from mechanical ventilation. The primary end-point was extubation tolerance (ET) assessed at 48 h. Results: Of 70 enrolled patients, 82.4% (N = 56) tolerated extubation. While there was no difference in ΔTDI% between those who failed extubation (EF) compared to ET at 48 h (21.2% vs 20.1%, P =.64), diaphragms were thicker at expiration in ET patients (T exp 29.5 ± 8.1 vs 24.8 ± 5.2 mm, P =.047). Commonly used clinical weaning parameters, including rapid-shallow breathing index (RSBI) and negative inspiratory force (NIF) correlated better with diaphragm thickening fraction ΔTDI% than diaphragm thickness indices but were inferior predictors of extubation success compared to T exp.. Conclusion: Point-of-care ultrasonographic assessment of the diaphragm offers insight into the function of respiratory muscles and the limited ability to predict extubation success. Further research is necessary to better understand its potential use in MV liberation in patients with ESLD and malnutrition. Plain Language Summary Title: Ultrasound assessment of diaphragm to predict extubation success in mechanically ventilated malnourished end-stage liver disease patients Plain Language Summary Predicting the ability to tolerate discontinuation of mechanical ventilation in patients with chronic medical conditions and acute respiratory failure is difficult as a large portion of these patients end up needing to be placed back on the respirators. Bedside ultrasonography represents a novel and promising tool helping physicians to better recognize which patients may have more difficulty to tolerate extubations, nevertheless little is known about how useful this approach may be in the population of debilitated and malnourished patients with end-stage liver failure. In order to answer this question, this observational study fails to identify the breathing-induced thickening of diaphragm muscle as a predictor of extubation tolerance, nevertheless identifies the decreased expiratory diameter of the diaphragm to be associated with extubation failure, confirming the relevance of ultrasound in the process of weaning from the mechanical ventilation. pubtype: Academic Journal doctype: diagnostic images research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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