Emmanuel Vivier1, Michel Muller2, Jean-Baptiste Putegnat3, Julie Steyer2, Stéphanie Barrau4, Florence Boissier4, Gaël Bourdin3, Armand Mekontso-Dessap5, Albrice Levrat2, Christian Pommier3, Arnaud W Thille4. 1. Hôpital Saint Joseph Saint Luc, Réanimation Polyvalente, Lyon, France. Electronic address: evivier@ch-stjoseph-stluc-lyon.fr. 2. Centre Hospitalier Annecy Genevoix, Réanimation Polyvalente, Metz-Tessy, France. 3. Hôpital Saint Joseph Saint Luc, Réanimation Polyvalente, Lyon, France. 4. CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France; INSERM CIC 1402 ALIVE, Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France. 5. INSERM (Dr Dessap), Unité U955, Créteil, France.
Abstract
BACKGROUND: Diaphragmatic dysfunction may promote weaning difficulties in patients who are mechanically ventilated. OBJECTIVE: The goal of this study was to assess whether diaphragm dysfunction detected by ultrasound prior to extubation could predict extubation failure in the ICU. METHODS: This multicenter prospective study included patients at high risk of reintubation: those aged > 65 years, with underlying cardiac or respiratory disease, or intubated > 7 days. All patients had successfully undergone a spontaneous breathing trial. Diaphragmatic function was assessed by ultrasound prior to extubation while breathing spontaneously on a T-piece. Bilateral diaphragmatic excursion and apposition thickening fraction were measured, and diaphragmatic dysfunction was defined as excursion < 10 mm or thickening < 30%. Cough strength was clinically assessed by physiotherapists. Extubation failure was defined as reintubation or death within the 7 days following extubation. RESULTS: Over a 20-month period, 191 at-risk patients were studied. Among them, 33 (17%) were considered extubation failures. The proportion of patients with diaphragmatic dysfunction was similar between those whose extubation succeeded and those whose extubation failed: 46% vs 51% using excursion (P = .55), and 71% vs 68% using thickening (P = .73), respectively. Values of excursion and thickening did not differ between the success and the failure groups: at right, excursion was 14 ± 7 mm vs 11 ± 8 (P = .13), and thickening was 29 ± 29% vs 38 ± 48% (P = .83), respectively. Extubation failure rates were 7%, 22%, and 46% in patients with effective, moderate, and ineffective cough (P < .01). Ineffective cough was the only variable independently associated with extubation failure. CONCLUSIONS: Diaphragmatic dysfunction assessed by ultrasound was not associated with an increased risk of extubation failure.
BACKGROUND:Diaphragmatic dysfunction may promote weaning difficulties in patients who are mechanically ventilated. OBJECTIVE: The goal of this study was to assess whether diaphragm dysfunction detected by ultrasound prior to extubation could predict extubation failure in the ICU. METHODS: This multicenter prospective study included patients at high risk of reintubation: those aged > 65 years, with underlying cardiac or respiratory disease, or intubated > 7 days. All patients had successfully undergone a spontaneous breathing trial. Diaphragmatic function was assessed by ultrasound prior to extubation while breathing spontaneously on a T-piece. Bilateral diaphragmatic excursion and apposition thickening fraction were measured, and diaphragmatic dysfunction was defined as excursion < 10 mm or thickening < 30%. Cough strength was clinically assessed by physiotherapists. Extubation failure was defined as reintubation or death within the 7 days following extubation. RESULTS: Over a 20-month period, 191 at-risk patients were studied. Among them, 33 (17%) were considered extubation failures. The proportion of patients with diaphragmatic dysfunction was similar between those whose extubation succeeded and those whose extubation failed: 46% vs 51% using excursion (P = .55), and 71% vs 68% using thickening (P = .73), respectively. Values of excursion and thickening did not differ between the success and the failure groups: at right, excursion was 14 ± 7 mm vs 11 ± 8 (P = .13), and thickening was 29 ± 29% vs 38 ± 48% (P = .83), respectively. Extubation failure rates were 7%, 22%, and 46% in patients with effective, moderate, and ineffective cough (P < .01). Ineffective cough was the only variable independently associated with extubation failure. CONCLUSIONS:Diaphragmatic dysfunction assessed by ultrasound was not associated with an increased risk of extubation failure.
Authors: Pieter R Tuinman; Annemijn H Jonkman; Martin Dres; Zhong-Hua Shi; Ewan C Goligher; Alberto Goffi; Chris de Korte; Alexandre Demoule; Leo Heunks Journal: Intensive Care Med Date: 2020-01-14 Impact factor: 17.440