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| Application of Diaphragm Ultrasound Combined with Lung Ultrasound in Ventilator Weaning in Critically Ill Patients |
| HU Riyang |
| First-author's address: Huizhou Huiyang Maternal and Child Health Hospital, Guangdong Province, Huizhou 516000, China |
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Abstract Objective: To evaluate the value of pulmonary ultrasound and diaphragmatic ultrasound in predicting the successful ventilator weaning of patients with critically traumatic ill patients. Method: A prospective analysis of 92 patients with severe traumatic who met the spontaneous breathing test (SBT) admitted to Huizhou Huiyang Maternal and Child Health Hospital from August 2020 to December 2021 was divided into successful and failed groups according to whether they were weaning. The general clinical data of the patients were collected, and the lung and diaphragm function were examined by bedside ultrasound 15 minutes after the start of SBT. Lung ultrasound score (LUS), diaphragmatic activity (DE), and diaphragmatic movement time (E-T) index were recorded and patient vital signs were monitored in real time. The statistically significant parameters in the univariate analysis were included in the multivariate logistic regression analysis to find independent prediction parameters. The receiver operating characteristic curve (ROC) was used to compare the sensitivity and specificity of the independent prediction parameters. Result: There were 55 cases in the successful group and 37 cases in the failed group. During SBT, the respiratory rate, heart rate and LUS score of the failed group were higher than those of the successful group, while the diaphragmatic activity, inspiratory time and E-T index of the failed group were lower than those of the successful group (P<0.05). Multivariate analysis showed that LUS score [OR=2.752, 95%CI (1.928, 3.575)], diaphragmatic activity [OR=4.329, 95%CI (3.309, 5.342)] and E-T index [OR=3.103, 95%CI (1.496, 4.711)] were predictors of offline failure (P<0.001). ROC analysis results showed that the AUC of LUS score was 0.692, the optimal cut-off value was 9.50 points, and the sensitivity and specificity were 0.72 and 0.51, respectively. The AUC of diaphragm activity was 0.861, the optimal cut-off value was 13.00 mm, and the sensitivity and specificity were 0.80 and 0.82, respectively. The AUC of E-T index was 0.794, the optimal cut-off value was 1.91, and the sensitivity and specificity were 0.76 and 0.79, respectively. The AUC was up to 0.932, and the sensitivity and specificity were 0.93 and 0.90, respectively. Conclusion: During SBT, a lower LUS score, a higher diaphragmatic activity, and a larger E-T index indicate a successful weaning outcome. The combined detection of three indicators can better predict the success of patients weaning.
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Received: 07 December 2022
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