Acute Crit Care.  2022 Feb;37(1):94-100. 10.4266/acc.2021.01354.

Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index

• Alam MJ
• Roy S
• Iktidar MA
• Padma FK
• Nipun KI
• Chowdhury S
• Nath RK
• Rashid HO

• KMID: 2527911
• DOI: http://doi.org/10.4266/acc.2021.01354

Abstract

Background
In 3%–19% of patients, reintubation is needed 48–72 hours following extubation, which increases intensive care unit (ICU) morbidity, mortality, and expenses. Extubation failure is frequently caused by diaphragm dysfunction. Ultrasonography can be used to determine the mobility and thickness of the diaphragm. This study looked at the role of diaphragm excursion (DE) and thickening fraction in predicting successful extubation from mechanical ventilation.
Methods
Thirty-one patients were extubated with the advice of an ICU consultant using the ICU weaning regimen and diaphragm ultrasonography was performed. Ultrasound DE and thickening fraction were measured three times: at the commencement of the t-piece experiment, at 10 minutes, and immediately before extubation. All patients' parameters were monitored for 48 hours after extubation. Rapid shallow breathing index (RSBI) was also measured at the same time.
Results
Successful extubation was significantly correlated with DE (P=0.01). Receiver curve analysis for DE to predict successful extubation revealed good properties (area under the curve [AUC], 0.83; P<0.001); sensitivity, 77.8%; specificity, 84.6%, positive predictive value (PPV), 87.5%; negative predictive value (NPV), 73.3% while cut-off value, 11.43 mm. Diaphragm thickening fraction (DTF) also revealed moderate curve properties (AUC, 0.69; P=0.06); sensitivity, 61.1%; specificity, 84.6%; PPV, 87.5%; NPV, 61.1% with cut-off value 22.33% although former one was slightly better. RSBI could not reach good receiver operating characteristic value at cut-off points 100 b/min/L (AUC, 0.58; P=0.47); sensitivity, 66.7%; specificity, 53.8%; PPV, 66.7%; NPV, 53.8%).
Conclusions
To decrease the rate of reintubation, DE and DTF are better indicators of successful extubation. DE outperforms DTF.

Keyword

airway extubation; diaphragm excursion; diaphragm thickening fraction; rapid shallow breathing index; ventilator weaning

Figure

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  Figure 1. Comparison of receiver operating characteristic (ROC) curve for diaphragm excursion (DE), diaphragm thickening fraction (DTF), and rapid shallow breathing index (RSBI). Area under the ROC curves for DE: 0.83 (95% confidence interval [CI], 0.68–0.99), for DTF: 0.69 (95% CI, 0.49–0.88), and for RSBI: 0.58 (95% CI, 0.36–0.80).

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