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Diaphragm Ultrasound as a Novel Guide of Weaning From Invasive Ventilation
October 2015, Vol 148, No. 4_MeetingAbstracts
Critical Care | October 2015
Diaphragm Ultrasound as a Novel Guide of Weaning From Invasive Ventilation Gamal Agmy, MD; Samiaa Hamdy, MD; Sherin Farghally, MD Assiut University Hospital, Assiut Egypt, Assiut, Egypt Chest. 2015;148(4_MeetingAbstracts):327A. doi:10.1378/chest.2225632
Abstract SESSION TITLE: Novel Assessment and Treatments for Respiratory Failure SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 27, 2015 at 11:00 AM - 12:15 PM PURPOSE: Predictive guides of weaning from invasive ventilation are often erroneous. Among the numerous parameters used in clinical practice, the rapid shallow breathing index is one of the most accurate. The diaphragm thickening (DT) measured by ultrasound was evaluated as a weaning predictor compared with the rapid shallow breathing index. METHODS: A prospective study included 78 patients with COPD exacerbation. All patients were ventilated in pressure support through endotracheal tube. During spontaneous breathing trial (SBT), the right diaphragm was visualized in the zone of apposition using a 7.5 MHz linear ultrasound probe. DT was calculated as percentage from the following formula: Thickness at end inspiration − Thickness at end expiration / Thickness at end expiration. It was recorded at total lung capacity (TLC) and residual volume (RV). The rapid shallow breathing index (RSBI) was calculated. Weaning failure was defined as the inability to maintain spontaneous breathing for at least 48 h, without any form of ventilatory support. RESULTS: A significant difference between diaphragm thickness at TLC and RV was observed both in patients who succeeded SBT and patients who failed. DT was significantly different between patients who failed and patients who succeeded SBT. A cutoff value of a DTF >40% was associated with a successful SBT with a sensitivity of 88%, a specificity of 92%, a positive predictive value (PPV) of 95%, and a negative predictive value (NPV) of 82%. On the other hand , RSBI <105 had a sensitivity of 95%, a specificity of 90%, a PPV of 96%, and a NPV of 92% for determining SBT success. CONCLUSIONS: DT assessed by ultrasound is an excellent predictor of weaning outcome in COPD patients undergoing mechanical ventilation. CLINICAL IMPLICATIONS: Diaphragm ultasound can pedict weaning success in mechanically ventilated COPD patients.It has the advantages of bed side availability,safety, repeatability,low prise and radiation free. DISCLOSURE: The following authors have nothing to disclose: Gamal Agmy, Samiaa Hamdy, Sherin Farghally No Product/Research Disclosure Information
Critical Care | October 2015
Diaphragm Ultrasound as a Novel Guide of Weaning From Invasive Ventilation Gamal Agmy, MD; Samiaa Hamdy, MD; Sherin Farghally, MD Assiut University Hospital, Assiut Egypt, Assiut, Egypt Chest. 2015;148(4_MeetingAbstracts):327A. doi:10.1378/chest.2225632
Abstract SESSION TITLE: Novel Assessment and Treatments for Respiratory Failure SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 27, 2015 at 11:00 AM - 12:15 PM PURPOSE: Predictive guides of weaning from invasive ventilation are often erroneous. Among the numerous parameters used in clinical practice, the rapid shallow breathing index is one of the most accurate. The diaphragm thickening (DT) measured by ultrasound was evaluated as a weaning predictor compared with the rapid shallow breathing index. METHODS: A prospective study included 78 patients with COPD exacerbation. All patients were ventilated in pressure support through endotracheal tube. During spontaneous breathing trial (SBT), the right diaphragm was visualized in the zone of apposition using a 7.5 MHz linear ultrasound probe. DT was calculated as percentage from the following formula: Thickness at end inspiration − Thickness at end expiration / Thickness at end expiration. It was recorded at total lung capacity (TLC) and residual volume (RV). The rapid shallow breathing index (RSBI) was calculated. Weaning failure was defined as the inability to maintain spontaneous breathing for at least 48 h, without any form of ventilatory support. RESULTS: A significant difference between diaphragm thickness at TLC and RV was observed both in patients who succeeded SBT and patients who failed. DT was significantly different between patients who failed and patients who succeeded SBT. A cutoff value of a DTF >40% was associated with a successful SBT with a sensitivity of 88%, a specificity of 92%, a positive predictive value (PPV) of 95%, and a negative predictive value (NPV) of 82%. On the other hand , RSBI <105 had a sensitivity of 95%, a specificity of 90%, a PPV of 96%, and a NPV of 92% for determining SBT success. CONCLUSIONS: DT assessed by ultrasound is an excellent predictor of weaning outcome in COPD patients undergoing mechanical ventilation. CLINICAL IMPLICATIONS: Diaphragm ultasound can pedict weaning success in mechanically ventilated COPD patients.It has the advantages of bed side availability,safety, repeatability,low prise and radiation free. DISCLOSURE: The following authors have nothing to disclose: Gamal Agmy, Samiaa Hamdy, Sherin Farghally No Product/Research Disclosure Information