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The Egyptian Journal of Bronchology
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Diaphragm and weaning from mechanical ventilation: anticipation and outcome

Egyptian Journal of Bronchology volume 13, pages 489–497 (2019)Cite this article

Abstract

Background

Determining the optimal moment to extubate a critically ill patient remains a challenge. The parameters of diaphragm sonography offer precious data in the evaluation and follow-up of critically ill patients on mechanical ventilation.

Aim

To evaluate the diaphragm role in the weaning outcome through the following objectives: detect the association between ultrasonographic parameters of diaphragm [thickness, excursion, and velocity of contraction (slope)] and weaning outcome, success, or failure, in addition to evaluation of the weaning process by measuring the total duration of ventilation, weaning duration, ICU stay, and reventilation.

Patients and methods

A longitudinal, observational, prospective study. The primary endpoint was weaning outcome (failed or successful), while the secondary endpoints included length of ICU stay, weaning duration, ventilation duration, presence or absence of complications, and mortality. It was conducted on 240 (138 men and 102 women) invasively mechanically ventilated patients aged between 20 and 78 years were chosen from our Respiratory ICU of Chest Department, Mansoura University Hospital.

Results

There were statistically significant higher values of all sonographic measurements in the survived compared with the died group (P<0.001). There was statistically significantly higher sonographic diaphragmatic measurements in the successful group compared with the failed group (P<0.001).

Conclusion

The measurement of percent change of diaphragmatic thickness as well as excursion and slope could be applied in correlation more with weaning outcome with a sensitivity of 100% and specificity of 97.4%.

References

  1. Caroleo S, Agnello F, Abdallah K, Santangelo E, Amantea B. Weaning from mechanical ventilation: an open issue. Minerva Anestesiol 2007; 73:417–427.

    PubMed  CAS  Google Scholar 

  2. Vignon P, Repesse X, Vieillard-Baron A, Maury E. Critical care ultrasonography in acute respiratory failure. Crit Care 2016; 20:228.

    Article  Google Scholar 

  3. Sigala I, Vassilakopoulos T. Diaphragmatic ultrasound as a monitoring tool in the intensive care unit. Ann Transl Med 2017; 5:79.

    Article  Google Scholar 

  4. Rizk AM, Zidan MA, Emara DM, Abd El-Hady MA, Wahbi MO. Chest ultrasound in the assessment of patients in ICU: How can it help?. Egypt J Radiol Nucl Med 2017; 48;313–322.

    Article  Google Scholar 

  5. Mayo P, Arntfield R, Balik M. The ICM research agenda on critical care ultrasonography. Intensive Care Med 2017; 43:1257–1269.

    Article  CAS  Google Scholar 

  6. Llamas-Alvarez AM, Tenza-Lozano EM, Latour-Perez J. Diaphragm and lung ultrasound to predict weaning outcome, systematic review and metaanalysis. Chest 2017; 152:1140–1150.

    Article  Google Scholar 

  7. Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ. Bedside ultrasound assessment of positive end expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med 2011 183:341–347.

    Article  Google Scholar 

  8. Dube BP, Dres M. Diaphragm dysfunction: diagnostic approaches and management strategies. J Clin Med 2016 5:113.

    Article  Google Scholar 

  9. 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.

    Article  Google Scholar 

  10. Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C. Weaning from mechanical ventilation. Eur Respir J 2007 29:1033–1056.

    Article  Google Scholar 

  11. Mirzaei M, Pourmirza Kalhori R, Gh M, Khatoni A, Rezaei M. The effect of Riker sedation-agitation scale on clinical outcome of patients under coronary artery bypass graft surgery. Iran J Crit Care Nurs 2014; 6:223–228.

    Google Scholar 

  12. Yoo J, Lee SJ, Lee JD, Kim HC. Comparison of clinical utility between diaphragm excursion and thickening change using ultrasonography to predict extubation success. Korean J Intern Med 2018; 33:331–339.

    Article  Google Scholar 

  13. Bien Udos S, Souza GF, Campos ES, Farah de Carvalho E, Fernandes MG, Santoro I. Maximum inspiratory pressure and rapid shallow breathing index as predictors of successful ventilator weaning. J Phys Ther Sci 2015; 27:3723–3727.

    Article  Google Scholar 

  14. El-Khatib MF, Bou-Khalil P. Clinical review: liberation from mechanical ventilation. Crit Care 2008; 12:221.

    Article  Google Scholar 

  15. Vivier E, Mekontso Dessap A, Dimassi S, Vargas F, Lyazidi A, Thille AW. Diaphragm ultrasonography to estimate the work of breathing during non invasive ventilation. Intensive Care Med 2012; 38:796–803.

    Article  Google Scholar 

  16. McCool FD, Tzelepis GE. Dysfunction of the diaphragm. N Engl J Med 2012; 366:932–942.

    Article  CAS  Google Scholar 

  17. Heunks LM, Doorduin J, van der Hoeven JG. Monitoring and preventing diaphragm injury. Curr Opin Crit Care 2015; 21:34–41.

    Article  Google Scholar 

  18. Pirompanich P, Romsaiyut S. Use of diaphragm thickening fraction combined with rapid shallow breathing index for predicting success of weaning from mechanical ventilator in medical patients. J Intensive Care 2018; 6:6.

    Article  Google Scholar 

  19. Luo L, Li Y, Chen X, Sun B, Li W, Gu W. Different effects of cardiac and diaphragm function assessed by ultrasound on extubation outcomes in difficult-to-wean patients: a cohort study. BMC Pulm Med 2017; 17:161.

    Article  CAS  Google Scholar 

  20. Samanta S, Singh RK, Baronia AK, Poddar B, Azim A, Gurjar M. Diaphragm thickening fraction to predict Weaning: a prospective exploratory study. J Intensive Care 2017; 5:62.

    Article  Google Scholar 

  21. Goligher EC, Fan E, Herridge MS, Murray A, Voronal S, Brace D, et al. Evolution of diaphragm thickness during mechanical ventilation. Impact of inspiratory effort. Am J Respir Crit Care Med 2015; 192:1080–1088.

    Article  Google Scholar 

  22. Zambon M, Greco M, Bocchino S, Cabrini L, Beccaria PF, Alberto Zangrillo A. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intensive Care Med 2017; 43:29–38.

    Article  Google Scholar 

  23. Ferrari G, De 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.

    Article  Google Scholar 

  24. Baess AI, Abdallah TH, Emara DM, Hassan M. Diaphragmatic ultrasound as a predictor of successful extubation from mechanical ventilation: thickness, displacement, or both? Egypt J Bronchol 2016;162–166

  25. Ali ER, Mohamad AM. Diaphragm ultrasound as a new functional and morphological index of outcome, prognosis and discontinuation from mechanical ventilation in critically ill patients and evaluating the possible protective indices against VIDD. Egypt J Chest Dis Tubercu 2017; 66:339–351.

    Article  Google Scholar 

  26. Farghaly S, Hasan AA. Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients. Aust Crit Care 2017; 30:37–43.

    Article  Google Scholar 

  27. DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax 2014; 69:423–442.

    Article  Google Scholar 

  28. Agmy G, Hamdy S, Farghally S. Diaphragm ultrasound as a novel guide of weaning from invasive ventilation. Eur Respir J 2015; 46:3264.

    Google Scholar 

  29. Osman AM, Hashim RM. Diaphragmatic and lung ultrasound application as new predictive indices for the weaning process in ICU patients. Egypt J Radiol Nucl Med 2017; 48:61–66.

    Article  Google Scholar 

  30. Saeed AM, El Assal GI, Ali TM, Hendawy MM. Role of ultrasound in assessment of diaphragmatic function in chronic obstructive pulmonary disease patients during weaning from mechanical ventilation. Egypt J Bronchol 2016; 10:167–172.

    Article  Google Scholar 

  31. Hayat A, Khan A, Khalil A, Asghar A. Diaphragmatic excursion: does it predict successful weaning from mechanical ventilation?. J Coll Physicians Surg Pak 2017; 27:743–746

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Thoracic Medicine Department, Mansoura University Hospital, Mansoura, Egypt

    Rasha M. Abdelhafeez, Ahmed M. Abumossalam (Associate professor (MD) of Pulmonary and Critical Care Medicine), Eman O. Arram, Mohsen M. Elshafey & Mohammed E. Abushehata

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  1. Rasha M. Abdelhafeez
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  2. Ahmed M. Abumossalam
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  3. Eman O. Arram
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  4. Mohsen M. Elshafey
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  5. Mohammed E. Abushehata
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Corresponding author

Correspondence to Ahmed M. Abumossalam.

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Abdelhafeez, R.M., Abumossalam, A.M., Arram, E.O. et al. Diaphragm and weaning from mechanical ventilation: anticipation and outcome. Egypt J Bronchol 13, 489–497 (2019). https://doi.org/10.4103/ejb.ejb_13_19

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  • DOI: https://doi.org/10.4103/ejb.ejb_13_19

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