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Diaphragmatic Ultrasonography, a Novel Approach in Critical Care: A Proposal for a New Weaning Index.
Garrido-Aguirre, Eduardo; Ñamendys-Silva, Silvio A; Del Moral, Oscar Rojo; Cortés-Soto, Carlos A; Romero-González, Juan P.
Afiliação
  • Garrido-Aguirre E; Department of Critical Care Medicine, Medica Sur Clinic & Foundation.
  • Del Moral OR; Department of Critical Care Medicine, Instituto Mexicano del Seguro Social HGZ/MF #2.
  • Cortés-Soto CA; Department of Critical Care Medicine, Grupo Ángeles Clinica Londres, Mexico City, Mexico.
  • Romero-González JP; Department of Critical Care Medicine, Medica Sur Clinic & Foundation.
Ultrasound Q ; 36(1): 54-58, 2020 Mar.
Article em En | MEDLINE | ID: mdl-31008860
The evaluation of the diaphragm in critically ill patients is simple and noninvasive and has shown good repeatability. The aim of the study was to generate a predictive index for successful weaning (ULDIMex) from invasive mechanical ventilation (IMV) based on an ultrasonographic diaphragmatic assessment before performing a spontaneous breathing test. We recruited patients who required IMV and who were candidates for weaning from ventilation. The measurement of diaphragmatic excursion and time during inspiration and expiration was obtained with a 3- to 5-MHz probe in the M mode. Using the formula (a + b)c/2, the value for the ULDIMex was obtained to evaluate its impact on predicting the successful weaning of IMV, where a is the time during the inspiratory phase, b is the time during expiration, and c is the diaphragmatic excursion during the inspiratory phase, which corresponds to the highest point of the curve from the baseline. We recruited 114 patients, of whom 86 (76%) were successfully weaned from IMV. The patients who were successfully weaned from the IMV had a cutoff value greater than 4.06 cm/s for the ULDIMex index, with a sensitivity of 92.8% (95% confidence interval, 76.5-99.1), specificity of 63.9% (95% confidence interval, 52.9-74.0), positive predictive value of 45.6%, and negative predictive value of 96.5%. The ULDIMex index demonstrated a good level of discrimination for successful weaning prediction. Considering the excellent negative likelihood ratio of the ULDIMex index of greater than 4.06, this index may be considered before performing an spontaneous breathing test to identify critically ill adult patients who will extubate successfully.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Diafragma / Desmame do Respirador / Ultrassonografia / Estado Terminal Tipo de estudo: Diagnostic_studies Limite: Adult / Female / Humans / Male País/Região como assunto: Mexico Idioma: En Revista: Ultrasound Q Assunto da revista: DIAGNOSTICO POR IMAGEM Ano de publicação: 2020 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Diafragma / Desmame do Respirador / Ultrassonografia / Estado Terminal Tipo de estudo: Diagnostic_studies Limite: Adult / Female / Humans / Male País/Região como assunto: Mexico Idioma: En Revista: Ultrasound Q Assunto da revista: DIAGNOSTICO POR IMAGEM Ano de publicação: 2020 Tipo de documento: Article País de publicação: Estados Unidos