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Ultrasound Measures of Diaphragm Thickness and Liberation From Mechanical Ventilation
Critical Care SESSION TITLE: Ultrasound in the ICU SESSION TYPE: Original Investigation Slide PRESENTED ON: Monday, October 24, 2016 at 04:30 PM - 05:30 PM
Ultrasound Measures of Diaphragm Thickness and Liberation From Mechanical Ventilation Amanpreet Kaur MD* Dennis Oyiengo Taro Minami; and Franklin McCool Rhode Island Hospital/Brown University Alpert Medical School, Providence, RI PURPOSE: The aim of this study was to determine if ultrasound measures of diaphragm thickness during inspiration (delta tdi) decreases time on mechanical ventilation when compared to usual care (UC). Additionally, the study examined the acceptability of incorporating measures of delta tdi in decision making of intensivists. METHODS: This is a prospective randomized observational study in which we enrolled patients in the medical intensive care unit on invasive mechanical ventilation for more than 48 hours. Patients were identified based on their clinical readiness to undergo a spontaneous breathing trial (maximum PEEP of 8cmH20, FiO2 of less than 50%, oxygen saturation of more than 92%) and were randomized to UC or usual care enhanced with the clinician aware of the diaphragm ultrasound results (UCUS). All patients underwent measures of delta tdi. Only clinicians caring for patients in the UCUS group were informed that “there was a 90% likelihood of extubation success” if delta tdi was greater than 30% (DiNino et al, Thorax). RESULTS: 44 patients were consented and 32 (17 male, 15 female; Mean age: 56y for control group, 55y for ultrasound group) were studied. Fifteen patients were randomized into the UC group and 17 into the UCUS group. The most common admitting diagnosis was pneumonia. Thirteen patients were successfully extubated in UC and 14 patients UCUS. There was one failed extubation in both groups and one patient in UC and two patients in UCUS underwent tracheostomy. The time spent on mechanical ventilation was less for the UCUS group (1.12 days vs 1.8 days). Twelve out of 17 times, the physicians caring for patients in the UCUS group found the results slightly helpful in their decision making. CONCLUSIONS: Knowledge of measurements of delta tdi may help decrease time spent on mechanical ventilation. CLINICAL IMPLICATIONS: With increasing use of ultrasonography in the critical care setting, standardization of an extubation protocol utilizing diaphragm measurements may improve patient outcomes with early liberation from mechanical ventilation.
No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.480
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
467A
CRITICAL CARE
DISCLOSURE: The following authors have nothing to disclose: Amanpreet Kaur, Dennis Oyiengo, Taro Minami, Franklin McCool
Ultrasound Measures of Diaphragm Thickness and Liberation From Mechanical Ventilation Amanpreet Kaur MD* Dennis Oyiengo Taro Minami; and Franklin McCool Rhode Island Hospital/Brown University Alpert Medical School, Providence, RI PURPOSE: The aim of this study was to determine if ultrasound measures of diaphragm thickness during inspiration (delta tdi) decreases time on mechanical ventilation when compared to usual care (UC). Additionally, the study examined the acceptability of incorporating measures of delta tdi in decision making of intensivists. METHODS: This is a prospective randomized observational study in which we enrolled patients in the medical intensive care unit on invasive mechanical ventilation for more than 48 hours. Patients were identified based on their clinical readiness to undergo a spontaneous breathing trial (maximum PEEP of 8cmH20, FiO2 of less than 50%, oxygen saturation of more than 92%) and were randomized to UC or usual care enhanced with the clinician aware of the diaphragm ultrasound results (UCUS). All patients underwent measures of delta tdi. Only clinicians caring for patients in the UCUS group were informed that “there was a 90% likelihood of extubation success” if delta tdi was greater than 30% (DiNino et al, Thorax). RESULTS: 44 patients were consented and 32 (17 male, 15 female; Mean age: 56y for control group, 55y for ultrasound group) were studied. Fifteen patients were randomized into the UC group and 17 into the UCUS group. The most common admitting diagnosis was pneumonia. Thirteen patients were successfully extubated in UC and 14 patients UCUS. There was one failed extubation in both groups and one patient in UC and two patients in UCUS underwent tracheostomy. The time spent on mechanical ventilation was less for the UCUS group (1.12 days vs 1.8 days). Twelve out of 17 times, the physicians caring for patients in the UCUS group found the results slightly helpful in their decision making. CONCLUSIONS: Knowledge of measurements of delta tdi may help decrease time spent on mechanical ventilation. CLINICAL IMPLICATIONS: With increasing use of ultrasonography in the critical care setting, standardization of an extubation protocol utilizing diaphragm measurements may improve patient outcomes with early liberation from mechanical ventilation.
No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.480
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
467A
CRITICAL CARE
DISCLOSURE: The following authors have nothing to disclose: Amanpreet Kaur, Dennis Oyiengo, Taro Minami, Franklin McCool