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Role of ultrasound in assessment of diaphragmatic function in chronic obstructive pulmonary disease patients during weaning from mechanical ventilation
Egyptian Journal of Bronchology volume 10, pages 167–172 (2016)
Abstract
Objectives
The aim of the study was to investigate the role of ultrasound in the evaluation of movement of the diaphragm and its value in predicting successful extubation in mechanically ventilated chronic obstructive pulmonary disease (COPD) patients in relation to other weaning parameters.
Introduction
Chest ultrasound is a beneficial tool for evaluation of the diaphragm during weaning from mechanical ventilation in COPD patients. Chest ultrasound offers some advantages over fluoroscopy, including the lack of ionizing radiation and the possibility of use at the bedside of the patient, as well as facilitating direct quantification of the movement of the diaphragm.
Patients and methods
The present study was conducted on 50 patients in the respiratory ICU and the Chest Department of Ain Shams University Hospitals. Patients were divided into two groups: group A and group B. Group A consisted of 30 mechanically ventilated COPD patients admitted to the respiratory ICU and group B consisted of 20 COPD patients not mechanically ventilated during attendance at the Chest Department.
Results
Diaphragmatic movement was assessed in the two groups. The mean value of diaphragmatic displacement was higher in group B. In group A this value was higher among those with successful weaning using a cutoff value of 1.1 cm with sensitivity of 86.4%, specificity of 87.5%, and accuracy of 89.5%. There was a significant correlation between diaphragmatic displacement and other weaning parameters, which was better in the group with successful weaning.
Conclusion
Diaphragmatic displacement measured by ultrasound is one of the most sensitive, specific, and accurate parameters for weaning of COPD patients from mechanical ventilation, especially in relationship with other weaning parameters.
References
Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006; 27:397–412.
Summerhill EM, El-Sameed YA, Glidden TJ, McCool FD. Monitoring recovery from diaphragm paralysis with ultrasound. Chest 2008; 133: 737–774.
Epstein SK. Extubation. Respir Care 2002; 47:483–492.
Robriquet L, Georges H, Leroy O, Devos P, D’escrivan T, Guery B. Predictors of extubation failure in patients with chronic obstructive pulmonary disease. J Crit Care 2006; 21:190–192.
Vassilakopoulos T, Zakynthinos S, Roussos C. Respiratory muscles and weaning failure. Eur Respir J 1996; 9:2383–2400.
Ferrari G, Filippi G, Elia F, Panero F, Volpicelli G, Aprà F. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J 2014; 6:8–14.
Matamis D, Soilemezi E, Tsagourias M, Akoumianaki E, Dimassi S, Boroli F, et al. Sonographic evaluation of the diaphragm in critically ill patients: technique and clinical applications. Intensive Care Med 2013; 39: 801–810.
Yamaguti WPS, Paulin E, Shibao S, Kodaira S, Chammas MC, Carvalho CRF. Ultrasound evaluation of diaphragmatic mobility in different postures in healthy subjects. J Bras Pneumol 2007; 33:407–413.
Jiang JR, Tsai TH, Jerng JS, Yu CJ, Wu HD, Yang PC. Ultrasonographic evaluation of liver and spleen movements and extubation outcome. Chest 2004; 126:179–185.
Ongel EA, Karakurt Z, Salturk C, Takir HB, Burunsuzoglu B, Kargin F, et al. How do COPD comorbidities affect ICU outcomes? Int J Chron Obstruct Pulmon Dis 2014; 9:1187–1196.
Mabrouk AA, Mansour OF, Abd El-Aziz AA, Elhabashy MM, Alasdoudy AA. Evaluation of some predictors for successful weaning from mechanical ventilation. Egypt J Chest Dis Tuberc 2015; 64:703–707.
Nemer SN, Barbas CS, Caldeira JB, Cárias TC, Santos RG, Almeida LC, et al. A new integrative weaning index of discontinuation from mechanical ventilation. Crit Care 2009; 13:152–161.
Alvisi R, Volta CA, Righini ER, Capuzzo M, Ragazzi R, Verri M, et al. Predictors of weaning outcome in chronic obstructive pulmonary disease patients. Eur Respir J 2000; 15:656–662.
Fadaii A, Amini SS, Bagheri B, Taherkhanch B. Assessment of rapid shallow breathing index as a predictor for weaning in respiratory care unit. Tanaffos 2012; 11:28–31.
Nava S, Ambrosino N, Clini E, Prato M, Orlando G, Vitacca M, et al. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to COPD. Ann Intern Med 1998; 128:721–728.
Nemer SN, Barbas CS. Predictive parameters for weaning from mechanical ventilation. J Bras Pneumol 2011; 37:669–679.
Makhlouf H, Elkholy M, Salama S. Ultrasongraphic evaluation of diaphragmatic movement as a new parameter to predict weaning outcome in mechanically ventilated patients. Egypt J Chest 2008; 57:115–120.
El Hoffy MM, Khamis HM. Ultrasongraphic assessment of diaphragmatic movement as a predictor of extubation outcome in mechanically ventilated patients. Egypt J Chest 2008; 57:110–114.
Gerscovich EO, Cronan M, McGahan JP, Jain K, Jones D, McDonald C. Ultrasonographic evaluation of diaphragmatic motion. J Ultrasound Med 2001; 20:597–604.
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Saeed, A.M., El Assal, G.I., Ali, T.M. et al. Role of ultrasound in assessment of diaphragmatic function in chronic obstructive pulmonary disease patients during weaning from mechanical ventilation. Egypt J Bronchol 10, 167–172 (2016). https://doi.org/10.4103/1687-8426.184363
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DOI: https://doi.org/10.4103/1687-8426.184363