The impact of heart, lung and diaphragmatic ultrasound on prediction of failed extubation from mechanical ventilation in critically ill patients: a prospective observational pilot study.

IF 3.6 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Kavi Haji, Darsim Haji, David J Canty, Alistair G Royse, Cameron Green, Colin F Royse
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引用次数: 31

Abstract

Background: Failed extubation from mechanical ventilation in critically ill patients is multifactorial, complex and not well understood. We aimed to identify whether combined transthoracic echocardiography, lung and diaphragmatic ultrasound can predict extubation failure in critically ill patients.

Results: Fifty-three participants who were intubated > 48 h and deemed by the treating intensivist ready for extubation underwent a 60-min pre-extubation weaning trial (pressure support ≤ 10 cmH2O and positive end expiratory pressure 5 cmH2O). Prior to extubation, data collected included ultrasound assessment of left ventricular ejection fraction, left atrial area, early diastolic trans-mitral flow velocity wave (E), early diastolic trans-mitral flow velocity wave/late diastolic trans-mitral flow velocity wave (E/A), early diastolic trans-mitral flow velocity wave/early diastolic mitral annulus velocity (E/E'), interatrial septal motion, lung loss of aeration score and diaphragm movement. At the end of the weaning trial, the rapid shallow breathing index and serum B-type natriuretic peptide concentration were measured. Success and failure of weaning was assessed by defined criteria. Decision to extubate was at the discretion of the treating intensivist. Failure of extubation was defined as re-intubation, non-invasive ventilation or death within 48 h after extubation. Of 53 extubated participants, 11 failed extubation. Failed extubation was associated with diabetes, ischaemic heart disease, higher E/E' (OR 1.27, 95% CI 1.05-1.54), left atrial area (OR 1.14, CI 1.02-1.28), fixed rightward curvature of the interatrial septum (OR 12.95, CI 2.73-61.41), and higher loss of aeration score of anterior and lateral regions of the lungs (OR 1.41, CI 1.01-1.82).

Conclusions: Failed extubation in mechanically ventilated patients is more prevalent if markers of left ventricular diastolic dysfunction and loss of lung aeration are present.

心肺膈超声对危重患者机械通气拔管失败预测的影响:一项前瞻性观察性先导研究
背景:危重患者机械通气拔管失败是多因素的,复杂的,尚未得到很好的理解。我们的目的是确定联合经胸超声心动图、肺和膈超声是否可以预测危重患者拔管失败。结果:53例插管> 48 h且经治疗强化医师认为准备拔管的患者进行了60分钟拔管前脱机试验(压力支持≤10 cmH2O,呼气末正压5 cmH2O)。拔管前,收集的数据包括超声评估左室射血分数、左房面积、舒张早期经二尖瓣血流速度波(E)、舒张早期经二尖瓣血流速度波/舒张晚期经二尖瓣血流速度波(E/A)、舒张早期经二尖瓣血流速度波/舒张早期二尖瓣环速度(E/E’)、房间隔运动、肺通气功能丧失评分和隔膜运动。在断奶试验结束时,测定快速浅呼吸指数和血清b型利钠肽浓度。根据确定的标准评估断奶的成功和失败。是否拔管由治疗重症医师决定。拔管失败定义为再次插管、无创通气或拔管后48 h内死亡。53例拔管患者中,11例拔管失败。拔管失败与糖尿病、缺血性心脏病、较高的E/E′(OR 1.27, 95% CI 1.05-1.54)、左房区(OR 1.14, CI 1.02-1.28)、房间隔固定向右弯曲(OR 12.95, CI 2.73-61.41)以及肺前部和外侧区域较高的通气损失评分(OR 1.41, CI 1.01-1.82)相关。结论:在机械通气患者中,如果存在左心室舒张功能障碍和肺通气丧失的标志物,拔管失败更为普遍。
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来源期刊
Critical Ultrasound Journal
Critical Ultrasound Journal RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
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审稿时长
13 weeks
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