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VOLUME 22 , ISSUE 6 ( 2018 ) > List of Articles

RESEARCH ARTICLE

Comparison of lung ultrasound-based weaning indices with rapid shallow breathing index: Are they helpful?

Keywords : Extubation predictor, lung ultrasound, rapid shallow breathing index, weaning process

Citation Information : Comparison of lung ultrasound-based weaning indices with rapid shallow breathing index: Are they helpful?. Indian J Crit Care Med 2018; 22 (6):435-440.

DOI: 10.4103/ijccm.IJCCM_331_17

License: CC BY-ND 3.0

Published Online: 01-02-2015

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Background and Aims: The diaphragm is considered the main respiratory muscle and difficulty in weaning can occur because of impaired diaphragmatic function. Hence, monitoring diaphragmatic function is important. The aim of this study is to assess the ability of various lung ultrasound (US) indices and the rapid shallow breathing index (RSBI) to predict the outcome of the weaning process and compare them with RSBI. Materials and Methods: This was a prospective study conducted on patients admitted to critical care unit at a tertiary care hospital in north India from February 2017 to June 2017. Patients were put to spontaneous breathing trial (SBT) when they met the weaning criteria. Initial US was done immediately after putting the patient on SBT to check anatomy of the diaphragm and rule out patients according to exclusion criteria. This was followed by complete lung US (LUS) after 20 min of SBT. Results: The RSBI performed better than all other parameters, with an area under the curve (AUC) of 0.996. The sensitivity and specificity is 100%. Only comparable to RSBI is the speed of diaphragmic contraction (DC) which has AUC of 0.93. All other parameters had an AUC <0.8. Moreover, the DC and LUS score are strongly positively correlated with RSBI, whereas diaphragmic excursion and diaphragmic thickness fraction (DTF %) are weakly correlated. Conclusion: In Intensive Care Unit, RSBI is the best clinical tool for weaning, and DC is found to be the best parameter for weaning among the US-based weaning parameters. It can even be a substitute for RSBI, in today's world of real-time monitoring methods.


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  1. Epstein SK. Extubation. Respir Care 2002;47:483-92.
  2. Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: A 28-day international study. JAMA 2002;287:345-55.
  3. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991;324:1445-50.
  4. Ely EW, Baker AM, Evans GW, Haponik EF. The prognostic significance of passing a daily screen of weaning parameters. Intensive Care Med 1999;25:581-7.
  5. Stroetz RW, Hubmayr RD. Tidal volume maintenance during weaning with pressure support. Am J Respir Crit Care Med 1995;152:1034-40.
  6. Lee KH, Hui KP, Chan TB, Tan WC, Lim TK. Rapid shallow breathing (frequency-tidal volume ratio) did not predict extubation outcome. Chest 1994;105:540-3.
  7. Ferrari G, De Filippi G, Elia F, Panero F, Volpicelli G, Aprà F, et al. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J 2014;6:8.
  8. 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;39:801-10.
  9. Mayo P, Volpicelli G, Lerolle N, Schreiber A, Doelken P, Vieillard-Baron A, et al. Ultrasonography evaluation during the weaning process: The heart, the diaphragm, the pleura and the lung. Intensive Care Med 2016;42:1107-17.
  10. Soummer A, Perbet S, Brisson H, Arbelot C, Constantin JM, Lu Q, et al. Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit Care Med 2012;40:2064-72.
  11. Hershenson MB, Kikuchi Y, Tzelepis GE, McCool FD. Preferential fatigue of the rib cage muscles during inspiratory resistive loaded ventilation. J Appl Physiol (1985) 1989;66:750-4.
  12. Hershenson MB, Kikuchi Y, Loring SH. Relative strengths of the chest wall muscles. J Appl Physiol (1985) 1988;65:852-62.
  13. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: Methods, reproducibility, and normal values. Chest 2009;135:391-400.
  14. Lerolle N, Guérot E, Dimassi S, Zegdi R, Faisy C, Fagon JY, et al. Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery. Chest 2009;135:401-7.
  15. Saeed A, El Assal G, Ali TM. Role of ultrasound in assessment of diaphragmatic function in chronic obstructive pulmonary disease patients during weaning from mechanical ventilation. Egypt J Bronchol 2016;10:167-72.
  16. Baess A, Abdallah TH, Emara DM. Diaphragmatic ultrasound as a predictor of successful extubation from mechanical ventilation: Thickness, displacement, or both? Egypt J Bronchol 2016;10:162-6.
  17. DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax 2014;69:423-7.
  18. Vivier E, Mekontso Dessap A, Dimassi S, Vargas F, Lyazidi A, Thille AW, et al. Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation. Intensive Care Med 2012;38:796-803.
  19. 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;10:162-6.
  20. Steier J, Kaul S, Seymour J, Jolley C, Rafferty G, Man W, et al. The value of multiple tests of respiratory muscle strength. Thorax 2007;62:975-80.
  21. Soilemezi E, Tsagourias M, Talias MA, Soteriades ES, Makrakis V, Zakynthinos E, et al. Sonographic assessment of changes in diaphragmatic kinetics induced by inspiratory resistive loading. Respirology 2013;18:468-73.
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