Ultrasound-assessed diaphragmatic dysfunction as a predictor of weaning outcome in mechanically ventilated patients with sepsis in intensive care unit

Saad, Mohamed Ahmed; Nashed, Sherif Wadie; El-Shaer, Ahmed Nagah; Elagamy, Ashraf Elsayed; El Derh, Maha Sadek

doi:10.1186/s42077-022-00211-8

Ultrasound-assessed diaphragmatic dysfunction as a predictor of weaning outcome in mechanically ventilated patients with sepsis in intensive care unit

Authors

10.1186/s42077-022-00211-8

Abstract

Background
Weaning from mechanical ventilation is one of the most common challenges in the intensive care unit (ICU). Most of predictive indices of weaning from mechanical ventilation are often inaccurate. This study was performed to assess the accuracy of diaphragmatic ultrasonography for predicting weaning outcome in mechanically ventilated patients with sepsis in ICU.
Results
Sixty patients with sepsis in medical ICU were prospectively enrolled. All patients were ventilated in pressure support. Patients underwent a spontaneous breathing trial (SBT) on T-piece when they met all the following criteria: FiO < 0.6, PEEP ≤5 cmHO, PaO/FiO > 200, respiratory rate <30 breaths per minute, absence of fever, alert and cooperative, hemodynamic stability without or with low-dose vasoactive therapy support, and rapid shallow breathing index (RSBI)<105. During the trial, the patient was instructed to perform deep breathing to total lung capacity (TLC) and then exhaling to residual volume (RV) and the diaphragm was visualized in the 8th or 9th intercostal space between anterior and mid-axillary lines using a 3–5-MHz curved ultrasound probe to measure diaphragmatic excursion (DE) and a 7–11-MHz linear ultrasound probe to measure diaphragmatic thickness (DT) at TLC and RV, and the diaphragmatic thickness fraction (DTF) was calculated as percentage from the following formula (thickness at end inspiration—thickness at end expiration)/thickness at end expiration. According to weaning outcome, patients were divided into 2 groups: successful weaning group and weaning failure group. Weaning failure was defined as the inability to maintain spontaneous breathing for at least 48 h, without any form of ventilatory support.
Conclusions
Ultrasonography-based determination of diaphragm function by assessing DTF and DE can be used as predictor of weaning outcome in mechanically ventilated patients with sepsis.

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