Integration of Diaphragmatic Ultrasonography and Intra-Abdominal Pressure Measurement for Optimizing Weaning from Mechanical Ventilation.

IF 2.7 4区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Risk Management and Healthcare Policy Pub Date : 2025-05-08 eCollection Date: 2025-01-01 DOI:10.2147/RMHP.S502810

Dan Su, Ruixin Li, Zhi Chen, Na Cui, Zhanbiao Yu, Xiaoxu Ding, Jiaqian Wu

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引用次数: 0

Abstract

Objective: The objective of this study was to evaluate the effectiveness of diaphragmatic ultrasonography in conjunction with intra-abdominal pressure (IAP) measurement for assessing diaphragm function and determining the optimal timing for weaning from mechanical ventilation (MV).

Methods: A cohort of 100 patients undergoing MV at the intensive care department of the Affiliated Hospital of Hebei University between January 2023 and July 2023 was enrolled. Spontaneous breathing trials (SBTs) were performed once patients met the weaning criteria. At the 30-minute mark of the SBT, diaphragmatic ultrasonography and IAP measurements were conducted. Based on weaning outcomes, patients were categorized into successful and failed weaning groups. Diaphragmatic excursion (DE), diaphragm thickening fraction (TFdi), diaphragmatic rapid shallow breathing index (D-RSBI), and IAP were compared between groups. The predictive value of these parameters in determining optimal weaning timing was analyzed using receiver operator characteristic (ROC) curves.

Results: Compared to the failed weaning group, the successful weaning group exhibited significantly lower values of D-RSBI and IAP values along with higher values of DE, TFdi, diaphragm thickness at end-inhalation (DTei), and diaphragm thickness at end-exhalation (DTee) (p < 0.05). In the single-parameter analysis, the area under the curve (AUC) values for D-RSBI, DE, TFdi, and IAP were 0.880 (95% CI: 0.811-0.948), 0.981 (95% CI: 0.960-1.000), 0.907 (95% CI: 0.872-0.972), and 0.838 (95% CI: 0.748-0.929), respectively. The optimal cut-off values were 13.5 breaths /(min*cm), 1.2 cm, 29.3%, and 5.6 mmHg, respectively. In combined parameter analysis, the combination of IAP and DE demonstrated the highest predictive accuracy.

Conclusion: The integration of diaphragmatic ultrasonography with IAP measurement is an effective approach for predicting weaning outcomes in patients undergoing MV. This combined assessment may assist clinicians in optimizing weaning strategies and improving patient outcomes.

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横膈膜超声和腹内压测量的结合对机械通气脱机的优化。

目的：本研究的目的是评估膈超声检查与腹内压（IAP）测量在评估膈功能和确定机械通气（MV）最佳脱机时间方面的有效性。方法：选取2023年1月至2023年7月在河北大学附属医院重症监护室接受MV治疗的100例患者为研究对象。一旦患者达到脱机标准，就进行自主呼吸试验（sbt）。在SBT 30分钟标记时，进行膈超声检查和IAP测量。根据断奶结果，将患者分为成功断奶组和失败断奶组。比较两组间膈偏移（DE）、膈增厚分数（TFdi）、膈快速浅呼吸指数（D-RSBI）和IAP。使用受试者操作特征（ROC）曲线分析这些参数对确定最佳断奶时间的预测价值。结果：与脱机失败组相比，脱机成功组D-RSBI和IAP值显著降低，DE、TFdi、吸气末膈膜厚度（DTei）、呼气末膈膜厚度（DTee）值显著升高（p < 0.05）。在单参数分析中，D-RSBI、DE、TFdi和IAP的曲线下面积（AUC）值分别为0.880 （95% CI: 0.811-0.948）、0.981 （95% CI: 0.960-1.000）、0.907 （95% CI: 0.872-0.972）和0.838 （95% CI: 0.748-0.929）。最佳临界值分别为13.5次呼吸/(min*cm)、1.2 cm、29.3%和5.6 mmHg。在组合参数分析中，IAP和DE的组合显示出最高的预测精度。结论：横膈膜超声与IAP测量相结合是预测中压术后患者脱机预后的有效方法。这种综合评估可以帮助临床医生优化断奶策略并改善患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Risk Management and Healthcare Policy Medicine-Public Health, Environmental and Occupational Health

CiteScore

6.20

自引率

2.90%

发文量

242

审稿时长

16 weeks

期刊介绍： Risk Management and Healthcare Policy is an international, peer-reviewed, open access journal focusing on all aspects of public health, policy and preventative measures to promote good health and improve morbidity and mortality in the population. Specific topics covered in the journal include: Public and community health Policy and law Preventative and predictive healthcare Risk and hazard management Epidemiology, detection and screening Lifestyle and diet modification Vaccination and disease transmission/modification programs Health and safety and occupational health Healthcare services provision Health literacy and education Advertising and promotion of health issues Health economic evaluations and resource management Risk Management and Healthcare Policy focuses on human interventional and observational research. The journal welcomes submitted papers covering original research, clinical and epidemiological studies, reviews and evaluations, guidelines, expert opinion and commentary, and extended reports. Case reports will only be considered if they make a valuable and original contribution to the literature. The journal does not accept study protocols, animal-based or cell line-based studies.