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Evaluation of diaphragm ultrasound in predicting extubation outcome in mechanically ventilated patients with COPD

  • Xia Zhang
  • Jing Yuan
  • Yong Zhan
  • Jingyi WuEmail author
  • Biaohu Liu
  • Peng Zhang
  • Tao Yu
  • Zhen Wang
  • Xiaogan Jiang
  • Weihua Lu
Original Article
  • 16 Downloads

Abstract

Background

To explore the value of the right hemi-diaphragmatic excursion (DE) and its variation in predicting extubation outcome in mechanically ventilated patients with COPD.

Methods

All included patients with COPD received mechanical ventilation (MV) and were ready to wean from MV. After patients passed the 30 min spontaneous breathing trail (SBT), extubation was considered to be feasible, and the right DE measured by ultrasound at 0 min, 5 min, and 30 min of SBT were named as DE0, DE5, and DE30, respectively.

Results

Twenty-five patients succeeded extubation; 12 patients failed. The area under receiver operator characteristic curve (AUCROC) of DE30 and ΔDE30−5 (the variation between 30 and 5 min) were 0.762 and 0.835; a cutoff value of DE30 > 1.72 cm and ΔDE30−5 > 0.16 cm were associated with a successful extubation with a sensitivity of 76% and 84%, a specificity of 75% and 83.3%, respectively. The predictive probability equation of the DE30 plus ∆DE30−5 was P = 1/[1 + e−(−5.625+17.689×∆DE30−5+1.802×DE30)], a cutoff value of P > 0.626 was associated with a successful extubation with the AUCROC of 0.867, a sensitivity of 92%, and a specificity of 83.3%.

Conclusion

The combination of DE30 and ∆DE30−5 could improve the predictive value and could be used as the predictor of extubation outcome in mechanically ventilated patients with COPD.

Keywords

COPD Diaphragm Ultrasonography Ventilator weaning 

Notes

Authors’ contributions

Authors’ contributions: X. Z. designed this study, supervised the study, and revised the manuscript. J. W., J. Y., and Y. Z. performed the study, contributed to the collection of data, and participated in writing the manuscript. The other authors were involved in the execution of the study and data collection. All the authors participated in writing the manuscript and in reviewing the final manuscript and approving it for publication.

Funding information

This study was supported by the Natural Science Research Project of the Higher Education in Anhui Province (KJ2016A730), the Research Project on Application of Commonweal Technology in Anhui Province (1704f0804048), and the Annual Scientific and Technological Projects of Wuhu City (2012hm35).

Compliance with ethical standards

The study protocol was approved by the ethics committee of the First Affiliated Hospital of Wannan Medical College, and informed consent was obtained from each patient’s family.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  • Xia Zhang
    • 1
  • Jing Yuan
    • 2
  • Yong Zhan
    • 2
  • Jingyi Wu
    • 2
    Email author
  • Biaohu Liu
    • 1
  • Peng Zhang
    • 2
  • Tao Yu
    • 2
  • Zhen Wang
    • 2
  • Xiaogan Jiang
    • 2
  • Weihua Lu
    • 2
  1. 1.Department of UltrasoundThe First Affiliated Hospital of Wannan Medical CollegeWuhuChina
  2. 2.Department of Intensive Care UnitThe First Affiliated Hospital of Wannan Medical CollegeWuhuChina

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