Eva Tenza-Lozano, Ana Llamas-Alvarez, Enrique Jaimez-Navarro, Javier Fernández-Sánchez
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For the predictive accuracy study, we included consecutively 69 patients on MV who were ready for weaning. We assessed interobserver agreement of ultrasound measurements, using the weighted kappa coefficient for LUSm score (modified lung ultrasound score) and the intraclass correlation coefficient (ICC) and Bland-Altman method for TI (diaphragm thickening index). We assessed the predictive value of LUSm and TI in weaning outcome by plotting the corresponding ROC curves.</p><p><strong>Results: </strong>We found adequate interobserver agreement for both LUSm (weighted kappa 0.95) and TI (ICC 0.78, difference according to Bland-Altman analysis ± 12.5%). LUSm showed good-moderate discriminative power for successful weaning and extubation (area under the ROC curve (AUC) for successful weaning 0.80, and sensitivity and specificity at optimal cut-off point 0.76 and 0.73, respectively; AUC for successful extubation 0.78, and optimal sensitivity and specificity 0.76 and 0.47, respectively. TI was more sensitive but less specific for predicting successful weaning (AUC 0.71, optimal sensitivity and specificity 0.93 and 0.48) and successful extubation (AUC 0.76, optimal sensitivity and specificity 0.93 and 0.58). The area under the ROC curve for predicting weaning success was 0.83 for both ultrasound measurements together.</p><p><strong>Conclusions: </strong>Interobserver agreement was excellent for LUSm and moderate-good for TI. A low TI value or high LUSm value indicates high risk of weaning failure.</p>","PeriodicalId":46598,"journal":{"name":"Critical Ultrasound Journal","volume":"10 1","pages":"12"},"PeriodicalIF":3.6000,"publicationDate":"2018-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13089-018-0094-3","citationCount":"44","resultStr":"{\"title\":\"Lung and diaphragm ultrasound as predictors of success in weaning from mechanical ventilation.\",\"authors\":\"Eva Tenza-Lozano, Ana Llamas-Alvarez, Enrique Jaimez-Navarro, Javier Fernández-Sánchez\",\"doi\":\"10.1186/s13089-018-0094-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Lung and diaphragm ultrasound methods have recently been introduced to predict the outcome of weaning from mechanical ventilation (MV). The aim of this study is to assess the reliability and accuracy of these techniques for predicting successful weaning in critically ill adults.</p><p><strong>Methods: </strong>We conducted two studies: a cross-sectional interobserver agreement study between two sonographers and a prospective cohort study to assess the accuracy of lung and diaphragm ultrasound for predicting weaning and extubation outcome. For the interobserver agreement study, we included 50 general critical care patients who were consecutively admitted to the ICU. For the predictive accuracy study, we included consecutively 69 patients on MV who were ready for weaning. We assessed interobserver agreement of ultrasound measurements, using the weighted kappa coefficient for LUSm score (modified lung ultrasound score) and the intraclass correlation coefficient (ICC) and Bland-Altman method for TI (diaphragm thickening index). We assessed the predictive value of LUSm and TI in weaning outcome by plotting the corresponding ROC curves.</p><p><strong>Results: </strong>We found adequate interobserver agreement for both LUSm (weighted kappa 0.95) and TI (ICC 0.78, difference according to Bland-Altman analysis ± 12.5%). LUSm showed good-moderate discriminative power for successful weaning and extubation (area under the ROC curve (AUC) for successful weaning 0.80, and sensitivity and specificity at optimal cut-off point 0.76 and 0.73, respectively; AUC for successful extubation 0.78, and optimal sensitivity and specificity 0.76 and 0.47, respectively. TI was more sensitive but less specific for predicting successful weaning (AUC 0.71, optimal sensitivity and specificity 0.93 and 0.48) and successful extubation (AUC 0.76, optimal sensitivity and specificity 0.93 and 0.58). The area under the ROC curve for predicting weaning success was 0.83 for both ultrasound measurements together.</p><p><strong>Conclusions: </strong>Interobserver agreement was excellent for LUSm and moderate-good for TI. 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引用次数: 44
摘要
背景:肺和膈超声方法最近被引入预测机械通气(MV)脱机的结果。本研究的目的是评估这些技术预测危重成人成功断奶的可靠性和准确性。方法:我们进行了两项研究:两名超声医师之间的横断面观察者间协议研究和一项前瞻性队列研究,以评估肺和膈超声预测脱机和拔管结果的准确性。对于观察者间协议研究,我们纳入了50名连续入住ICU的普通重症监护患者。为了预测准确性的研究,我们连续纳入了69例准备断奶的MV患者。我们评估超声测量的观察者间一致性,使用LUSm评分(改良肺超声评分)的加权kappa系数和TI(隔膜增厚指数)的类内相关系数(ICC)和Bland-Altman方法。我们通过绘制相应的ROC曲线来评估LUSm和TI对断奶结局的预测价值。结果:我们发现LUSm(加权kappa 0.95)和TI (ICC 0.78,根据Bland-Altman分析差异±12.5%)的观察者间一致性足够。LUSm对成功脱机和拔管具有中优判别能力(成功脱机的ROC曲线下面积(area under the ROC curve, AUC)为0.80,在最佳截断点的敏感性和特异性分别为0.76和0.73;拔管成功的AUC为0.78,最佳灵敏度和特异性分别为0.76和0.47。TI在预测成功脱机(AUC 0.71,最佳灵敏度和特异性分别为0.93和0.48)和成功拔管(AUC 0.76,最佳灵敏度和特异性分别为0.93和0.58)方面更敏感,但特异性较低。预测断奶成功的ROC曲线下面积为0.83。结论:观察者间的一致性对于LUSm是极好的,对于TI是中等好的。低TI值或高LUSm值表明断奶失败的风险高。
Lung and diaphragm ultrasound as predictors of success in weaning from mechanical ventilation.
Background: Lung and diaphragm ultrasound methods have recently been introduced to predict the outcome of weaning from mechanical ventilation (MV). The aim of this study is to assess the reliability and accuracy of these techniques for predicting successful weaning in critically ill adults.
Methods: We conducted two studies: a cross-sectional interobserver agreement study between two sonographers and a prospective cohort study to assess the accuracy of lung and diaphragm ultrasound for predicting weaning and extubation outcome. For the interobserver agreement study, we included 50 general critical care patients who were consecutively admitted to the ICU. For the predictive accuracy study, we included consecutively 69 patients on MV who were ready for weaning. We assessed interobserver agreement of ultrasound measurements, using the weighted kappa coefficient for LUSm score (modified lung ultrasound score) and the intraclass correlation coefficient (ICC) and Bland-Altman method for TI (diaphragm thickening index). We assessed the predictive value of LUSm and TI in weaning outcome by plotting the corresponding ROC curves.
Results: We found adequate interobserver agreement for both LUSm (weighted kappa 0.95) and TI (ICC 0.78, difference according to Bland-Altman analysis ± 12.5%). LUSm showed good-moderate discriminative power for successful weaning and extubation (area under the ROC curve (AUC) for successful weaning 0.80, and sensitivity and specificity at optimal cut-off point 0.76 and 0.73, respectively; AUC for successful extubation 0.78, and optimal sensitivity and specificity 0.76 and 0.47, respectively. TI was more sensitive but less specific for predicting successful weaning (AUC 0.71, optimal sensitivity and specificity 0.93 and 0.48) and successful extubation (AUC 0.76, optimal sensitivity and specificity 0.93 and 0.58). The area under the ROC curve for predicting weaning success was 0.83 for both ultrasound measurements together.
Conclusions: Interobserver agreement was excellent for LUSm and moderate-good for TI. A low TI value or high LUSm value indicates high risk of weaning failure.