Evaluation of diaphragm ultrasound in predicting extubation outcome in mechanically ventilated patients with COPD
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To explore the value of the right hemi-diaphragmatic excursion (DE) and its variation in predicting extubation outcome in mechanically ventilated patients with COPD.
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.
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%.
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.
KeywordsCOPD Diaphragm Ultrasonography Ventilator weaning
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.
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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