<strong>Abstract</strong> <em>Introduction: </em>Multiple studies have shown that diaphragmatic ultrasound can better predict outcome of weaning. The purpose of this study was to investigate the predictive value of two diaphragmatic ultrasound indices, diaphragmatic thickening (DTF) and excursion (DE) for weaning outcomes in surgical intensive care unit (ICU). <em>Patients and Methods:</em> The study included 60 cases whose mechanical ventilation (MV) time was >48 hours, and all eligibles were divided into either the weaning success group (n=45) or the weaning failure group (n=15). Diaphragm thickness, diaphragmatic excursion (DE) and diaphragmatic thickening fraction (DTF) were measured in the zone of apposition. The rapid shallow breathing index (RSBI) was also recorded. <em>Results: </em>The ventilatory treatment time (p=0,002) and length of ICU stay (p=0,005) in the weaning failure group was longer than the success group. Cut-off values of diaphragmatic measures associated with successful weaning were ≥ 30% for DTF and ≥ 14 mm for DE giving a sensitivity (Se), a specificity (Sp) of 84,4%; 73,3% and 83,3%; 83,3%, respectively.By comparison, RSBI < 80 had a sensitivity of 93,3%, a specificity of 70% for determining weaning success. The areas under the ROC curves for DTF, DE and RSBI were 0,843; 0,807 and 0,873, respectively. <em>Conclusions:</em> Ultrasound evaluation of diaphragmatic excursion (DE) and diaphragmatic thickness fraction (DTF) could be a good predictor of weaning outcome in a surgical intensive unit. It is recommended to consider the use of these parameters with RSBI consequently to improve weaning outcomes. <em>Keywords:</em> Weaning, diaphragm ultrasound, diaphragmatic dysfunction, rapid shallow breathing. <strong>References</strong> <ol> <li>Esteban A. Characteristics and Outcomes in Adult Patients Receiving Mechanical VentilationA 28-Day International Study. 2002;287(3):345. doi:10.1001/jama.287.3.345</li> <li>Hudson MB, Smuder AJ, Nelson WB, Bruells CS, Levine S, Powers SK. Both high level pressure support ventilation and controlled mechanical ventilation induce diaphragm dysfunction and atrophy. <em>Crit Care Med.</em> 2012;40(4):1254-1260. doi:10.1097/CCM.0b013e31823c8cc9</li> <li>Vassilakopoulos T, Zakynthinos S, Roussos C. The tension-time index and the frequency/tidal volume ratio are the major pathophysiologic determinants of weaning failure and success. <em>Am J Respir Crit Care Med.</em> 1998;158(2):378-385. doi:10.1164/ajrccm.158.2.9710084</li> <li>Vivier E, Mekontso Dessap A, Dimassi S, et al. Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation. <em>Intensive Care Med.</em> 2012;38(5):796-803. doi:10.1007/s00134-012-2547-7</li> <li>Boles J-M, Bion J, Connors A, et al. Weaning from mechanical ventilation. <em>Eur Respir J. </em>2007;29(5):1033-1056. doi:10.1183/09031936.00010206</li> <li>Thille AW, Harrois A, Schortgen F, Brun-Buisson C, Brochard L. Outcomes of extubation failure in medical intensive care unit patients. <em>Crit Care Med.</em> 2011;39(12):2612-2618. doi:10.1097/CCM.0b013e3182282a5a</li> <li>Farghaly S, Hasan AA. Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients. <em>Australian Critical Care. </em>2017;30(1):37-43. doi:10.1016/j.aucc.2016.03.004</li> <li>Spadaro S, Grasso S, Mauri T, et al. Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index. <em>Crit Care.</em> 2016;20(1):305. doi:10.1186/s13054-016-1479-y</li> <li>Kim WY, Suh HJ, Hong S-B, Koh Y, Lim C-M. Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation. <em>Crit Care Med.</em> 2011;39(12):2627-2630. doi:10.1097/CCM.0b013e3182266408</li> <li>DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. 2014;69(5):423-427. doi:10.1136/thoraxjnl-2013-204111</li> <li>Ferrari G, De Filippi G, Elia F, Panero F, Volpicelli G, Aprà F. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. <em>Crit Ultrasound J.</em> 2014;6(1):8. doi:10.1186/2036-7902-6-8.</li> </ol> <!--more--> <a href="https://vjsel.vn/wp-content/uploads/2022/05/BAI-9.pdf">Download PDF File</a>
Ngo Anh PhuongTrinh Van Dong Ngo Anh PhuongTrinh Van Dong