Ultrasound diagnosis for weaning critically ill patients from mechanical ventilator and ultrasonographic assessment of mediastinal displacement(PDF)
《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]
- Issue:
- 2020年第3期
- Page:
- 303-306
- Research Field:
- 医学影像物理
- Publishing date:
Info
- Title:
- Ultrasound diagnosis for weaning critically ill patients from mechanical ventilator and ultrasonographic assessment of mediastinal displacement
- Author(s):
- FENG Xiang; WANG Guangying; LI Changqing
- Department of Critical Care Medicine, Baogang Hospital of Inner Mongolia, Baotou 014010, China
- Keywords:
- Keywords: critically ill patient; ultrasound diagnosis; mechanical ventilation; mediastinal displacement
- PACS:
- R445.1
- DOI:
- DOI:10.3969/j.issn.1005-202X.2020.03.009
- Abstract:
- Abstract: Objective To analyze the effects of ultrasound diagnosis for ventilator weaning and mediastinal displacement assessment in critically ill patients undergoing mechanical ventilation. Methods A total of 96 critically ill patients who underwent mechanical ventilation for over 48 h and spontaneous breathing trial were enrolled in the study. Several indexes such as rapid shallow breath index (RSBI), diaphragm thickening fraction (DTF), diaphragm contraction velocity and maximal right diaphragmatic excursion (DE) of SBT were detected by ultrasound at different time points. The patients were divided into weaning success group and weaning failure group according to weaning results. The differences in the above indexes were compared between two groups. Meanwhile, receiver operating characteristic (ROC) curve was used to evaluate the predictive value of each index and their combination for weaning success at SBT 30 min. Results There were 62 cases of weaning success and 34 cases of weaning failure, with a weaning failure rate of 35.42%. At SBT 30 min, RSBI and diaphragm contraction velocity in weaning success group were lower than those in weaning failure group, while DTF and DE were higher than those in weaning failure group, with statistical significance (P<0.05). Logistic regression analysis found that the increases of RSBI and diaphragm contraction velocity and the decreases of DTF and DE were the independent risk factors for weaning failure (P<0.05). The results of ROC curves showed that the Cutoff values of RSBI, DTF, diaphragm contraction velocity and DE for predicting weaning failure were 74.19 times/min·L-1, 35.37%, 1.74 cm/s and 1.61 mm, respectively. The areas under the ROC curve (AUC) of the 4 indexes for predicting weaning failure were 0.798, 0.809, 0.774 and 0.870, respectively, while the AUC of their combination was 0.951, significantly higher than that of each index (P<0.05). Conclusion Ultrasound can not only monitor mediastinal displacement by RSBI, DTF, diaphragm contraction velocity and DE, but also well predict weaning results. Moreover, the diagnostic effect of the combination of RSBI, DTF, diaphragm contraction velocity and DE is better.
Last Update: 2020-04-02