Martin Dres1,2,3,4, Thomas Similowski5,2, Ewan C Goligher4,6, Tai Pham3,7,8, Liliya Sergenyuk5, Irene Telias3,4,6, Domenico Luca Grieco3,9,10, Wissale Ouechani5, Detajin Junhasavasdikul3,11, Michael C Sklar3,4, L Felipe Damiani3,12, Luana Melo3, Cesar Santis3,13,14, Lauriane Degravi5, Maxens Decavèle5,2, Laurent Brochard3,4, Alexandre Demoule5,2. 1. AP-HP, Groupe Hospitalier Universitaire, AP-HP, Sorbonne Université, Site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive Réanimation (Département R3S), Paris, France martin.dres@aphp.fr. 2. Sorbonne Université, INSERM, UMRS_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France. 3. Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada. 4. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 5. AP-HP, Groupe Hospitalier Universitaire, AP-HP, Sorbonne Université, Site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive Réanimation (Département R3S), Paris, France. 6. Division of Respirology, Dept of Medicine, University Health Network, Toronto, ON, Canada. 7. Hôpital Bicêtre, Service de Médecine Intensive - Réanimation, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France. 8. Équipe d'Épidémiologie Respiratoire Intégrative, Centre for Epidemiology and Population Health (CESP), Université Paris-Saclay, UVSQ, Université Paris-Sud, INSERM, Villejuif, France. 9. Dept of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 10. Dept of Anaesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy. 11. Dept of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 12. Carrera de Kinesiología, Departamento Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 13. Departamento de Medicina Interna, Universidad de Chile, Campus Sur, San Miguel, Chile. 14. Unidad de Pacientes Críticos, Hospital Barros Luco Trudeau, Santiago, Chile.
Abstract
BACKGROUND: This study investigated dyspnoea intensity and respiratory muscle ultrasound early after extubation to predict extubation failure. METHODS: The study was conducted prospectively in two intensive care units in France and Canada. Patients intubated for at least 48 h were studied within 2 h after an extubation following a successful spontaneous breathing trial. Dyspnoea was evaluated by a dyspnoea visual analogue scale (Dyspnoea-VAS) ranging from 0 to 10 and the Intensive Care Respiratory Distress Observational Scale (IC-RDOS). The ultrasound thickening fraction of the parasternal intercostal and the diaphragm was measured; limb muscle strength was evaluated using the Medical Research Council (MRC) score (range 0-60). RESULTS: Extubation failure occurred in 21 out of 122 enrolled patients (17%). The median (interquartile range (IQR)) Dyspnoea-VAS and IC-RDOS were higher in patients with extubation failure versus success: 7 (4-9) versus 3 (1-5) (p<0.001) and 3.7 (1.8-5.8) versus 1.7 (1.5-2.1) (p<0.001), respectively. The median (IQR) ratio of parasternal intercostal muscle to diaphragm thickening fraction was significantly higher and MRC was lower in patients with extubation failure compared with extubation success: 0.9 (0.4-2.1) versus 0.3 (0.2-0.5) (p<0.001) and 45 (36-50) versus 52 (44-60) (p=0.012), respectively. The thickening fraction of the parasternal intercostal and its ratio to diaphragm thickening showed the highest area under the receiver operating characteristic curve (AUC) for an early prediction of extubation failure (0.81). AUCs of Dyspnoea-VAS and IC-RDOS reached 0.78 and 0.74, respectively. CONCLUSIONS: Respiratory muscle ultrasound and dyspnoea measured within 2 h after extubation predict subsequent extubation failure.
BACKGROUND: This study investigated dyspnoea intensity and respiratory muscle ultrasound early after extubation to predict extubation failure. METHODS: The study was conducted prospectively in two intensive care units in France and Canada. Patients intubated for at least 48 h were studied within 2 h after an extubation following a successful spontaneous breathing trial. Dyspnoea was evaluated by a dyspnoea visual analogue scale (Dyspnoea-VAS) ranging from 0 to 10 and the Intensive Care Respiratory Distress Observational Scale (IC-RDOS). The ultrasound thickening fraction of the parasternal intercostal and the diaphragm was measured; limb muscle strength was evaluated using the Medical Research Council (MRC) score (range 0-60). RESULTS: Extubation failure occurred in 21 out of 122 enrolled patients (17%). The median (interquartile range (IQR)) Dyspnoea-VAS and IC-RDOS were higher in patients with extubation failure versus success: 7 (4-9) versus 3 (1-5) (p<0.001) and 3.7 (1.8-5.8) versus 1.7 (1.5-2.1) (p<0.001), respectively. The median (IQR) ratio of parasternal intercostal muscle to diaphragm thickening fraction was significantly higher and MRC was lower in patients with extubation failure compared with extubation success: 0.9 (0.4-2.1) versus 0.3 (0.2-0.5) (p<0.001) and 45 (36-50) versus 52 (44-60) (p=0.012), respectively. The thickening fraction of the parasternal intercostal and its ratio to diaphragm thickening showed the highest area under the receiver operating characteristic curve (AUC) for an early prediction of extubation failure (0.81). AUCs of Dyspnoea-VAS and IC-RDOS reached 0.78 and 0.74, respectively. CONCLUSIONS: Respiratory muscle ultrasound and dyspnoea measured within 2 h after extubation predict subsequent extubation failure.
Authors: Penny Andrews; Joseph Shiber; Maria Madden; Gary F Nieman; Luigi Camporota; Nader M Habashi Journal: Front Physiol Date: 2022-07-25 Impact factor: 4.755