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Iranpour Y, Zandifar A. Diaphragm muscle parameters as a predictive tool for weaning critically ill patients from mechanical ventilation: a systematic review and meta-analysis study. Eur J Transl Myol 2024; 34. [PMID: 39228235 DOI: 10.4081/ejtm.2024.12642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/13/2024] [Indexed: 09/05/2024] Open
Abstract
Diaphragmatic ultrasound, valued for its portability and safety, assesses both structural and functional aspects of the diaphragm. While some studies support its predictive value, others conflict. This meta-analysis aims to clarify diaphragmatic ultrasound's role in predicting successful liberation from mechanical ventilation in intensive care settings. A systematic search was performed on Web of Science, Scopus, and PubMed up to March, 2024. The search strategy included a combination of relevant medical subject heading (MeSH) terms and relevant keywords. We defined our eligibility criteria based on the PICO framework. Two authors performed the data extraction using a standardized sheet. The pooled mean difference was calculated using random effects model and Hedges' g along with SD estimation. R and RStudio were used for the statistical analysis and creating forest and funnel plots. The pooled mean difference was 7.25 (95% CI: 4.20, 10.21) for DE among the two groups. We found a statistically significant difference between the two groups indicating that those with successful weaning from intubation had higher means of DE compared to those with failed weaning attempt (p-value<0.01). The mean difference of DTF was also higher among those with successful weaning from intubation compared to those with failed weaning attempt with the pooled mean difference of 14.52 (95% CI: 10.51, 18.54, p-value<0.01). The mean difference of RSBI was lower among those with successful weaning from intubation compared to those with failed weaning attempt with the pooled mean difference of -28.86 (95% CI: -41.82, -15.91, p-value<0.01). Our results suggest that evaluating diaphragmatic excursion and thickening fraction can reliably anticipate successful liberation from mechanical ventilation. However, significant heterogeneity was present among the included studies. High-quality research, particularly randomized clinical trials, is required to further elucidate the role of diaphragmatic ultrasound in predicting weaning from mechanical ventilation.
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Affiliation(s)
- Yashar Iranpour
- Department of anesthesiology, Tehran University of Medical Science, Tehran.
| | - Afrooz Zandifar
- Department of Radiology, Tehran University of Medical Science, Tehran.
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Poddighe D, Van Hollebeke M, Choudhary YQ, Campos DR, Schaeffer MR, Verbakel JY, Hermans G, Gosselink R, Langer D. Accuracy of respiratory muscle assessments to predict weaning outcomes: a systematic review and comparative meta-analysis. Crit Care 2024; 28:70. [PMID: 38454487 PMCID: PMC10919035 DOI: 10.1186/s13054-024-04823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/29/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Several bedside assessments are used to evaluate respiratory muscle function and to predict weaning from mechanical ventilation in patients on the intensive care unit. It remains unclear which assessments perform best in predicting weaning success. The primary aim of this systematic review and meta-analysis was to summarize and compare the accuracy of the following assessments to predict weaning success: maximal inspiratory (PImax) and expiratory pressures, diaphragm thickening fraction and excursion (DTF and DE), end-expiratory (Tdiee) and end-inspiratory (Tdiei) diaphragm thickness, airway occlusion pressure (P0.1), electrical activity of respiratory muscles, and volitional and non-volitional assessments of transdiaphragmatic and airway opening pressures. METHODS Medline (via Pubmed), EMBASE, Web of Science, Cochrane Library and CINAHL were comprehensively searched from inception to 04/05/2023. Studies including adult mechanically ventilated patients reporting data on predictive accuracy were included. Hierarchical summary receiver operating characteristic (HSROC) models were used to estimate the SROC curves of each assessment method. Meta-regression was used to compare SROC curves. Sensitivity analyses were conducted by excluding studies with high risk of bias, as assessed with QUADAS-2. Direct comparisons were performed using studies comparing each pair of assessments within the same sample of patients. RESULTS Ninety-four studies were identified of which 88 studies (n = 6296) reporting on either PImax, DTF, DE, Tdiee, Tdiei and P0.1 were included in the meta-analyses. The sensitivity to predict weaning success was 63% (95% CI 47-77%) for PImax, 75% (95% CI 67-82%) for DE, 77% (95% CI 61-87%) for DTF, 74% (95% CI 40-93%) for P0.1, 69% (95% CI 13-97%) for Tdiei, 37% (95% CI 13-70%) for Tdiee, at fixed 80% specificity. Accuracy of DE and DTF to predict weaning success was significantly higher when compared to PImax (p = 0.04 and p < 0.01, respectively). Sensitivity and direct comparisons analyses showed that the accuracy of DTF to predict weaning success was significantly higher when compared to DE (p < 0.01). CONCLUSIONS DTF and DE are superior to PImax and DTF seems to have the highest accuracy among all included respiratory muscle assessments for predicting weaning success. Further studies aiming at identifying the optimal threshold of DTF to predict weaning success are warranted. TRIAL REGISTRATION PROSPERO CRD42020209295, October 15, 2020.
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Affiliation(s)
- Diego Poddighe
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, 3000, Leuven, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marine Van Hollebeke
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, 3000, Leuven, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Yasir Qaiser Choudhary
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, 3000, Leuven, Belgium
| | - Débora Ribeiro Campos
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Prêto, Brazil
| | - Michele R Schaeffer
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, 3000, Leuven, Belgium
| | - Jan Y Verbakel
- Department of Public Health and Primary Care, EPI-Centre, KU Leuven, Leuven, Belgium
- NIHR Community Healthcare Medtech and IVD Cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Greet Hermans
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Rik Gosselink
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, 3000, Leuven, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Health and Rehabilitation Sciences, Faculty of Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Daniel Langer
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, 3000, Leuven, Belgium.
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium.
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Al-Husinat L, Jouryyeh B, Rawashdeh A, Robba C, Silva PL, Rocco PRM, Battaglini D. The Role of Ultrasonography in the Process of Weaning from Mechanical Ventilation in Critically Ill Patients. Diagnostics (Basel) 2024; 14:398. [PMID: 38396437 PMCID: PMC10888003 DOI: 10.3390/diagnostics14040398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/22/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Weaning patients from mechanical ventilation (MV) is a complex process that may result in either success or failure. The use of ultrasound at the bedside to assess organs may help to identify the underlying mechanisms that could lead to weaning failure and enable proactive measures to minimize extubation failure. Moreover, ultrasound could be used to accurately identify pulmonary diseases, which may be responsive to respiratory physiotherapy, as well as monitor the effectiveness of physiotherapists' interventions. This article provides a comprehensive review of the role of ultrasonography during the weaning process in critically ill patients.
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Affiliation(s)
- Lou’i Al-Husinat
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Basil Jouryyeh
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (B.J.); (A.R.)
| | - Ahlam Rawashdeh
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (B.J.); (A.R.)
| | - Chiara Robba
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, 16132 Genova, Italy
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941, Brazil; (P.L.S.); (P.R.M.R.)
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941, Brazil; (P.L.S.); (P.R.M.R.)
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
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Salotagi S, Kannan A, Jindal A. Lung Ultrasound Score: Does It Really Predict Extubation Failure? Indian J Crit Care Med 2023; 27:855-856. [PMID: 37936808 PMCID: PMC10626243 DOI: 10.5005/jp-journals-10071-24516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
How to cite this article: Salotagi S, Kannan A, Jindal A. Lung Ultrasound Score: Does It Really Predict Extubation Failure? Indian J Crit Care Med 2023;27(11):855-856.
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Affiliation(s)
- Siddannagoud Salotagi
- Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Abinaya Kannan
- Department of Pediatrics, All India Institute of Medical Sciences, Puducherry, India
| | - Atul Jindal
- Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Chowdhury SR, Kundu R. Commentary on "Prediction of Successful Spontaneous Breathing Trial and Extubation of Trachea by Lung Ultrasound in Mechanically Ventilated Patients in Intensive Care Unit". Indian J Crit Care Med 2023; 27:596. [PMID: 37636859 PMCID: PMC10452783 DOI: 10.5005/jp-journals-10071-24508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
How to cite this article: Chowdhury SR, Kundu R. Commentary on "Prediction of Successful Spontaneous Breathing Trial and Extubation of Trachea by Lung Ultrasound in Mechanically Ventilated Patients in Intensive Care Unit." Indian J Crit Care Med 2023;27(8):596.
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Affiliation(s)
- Sumit Roy Chowdhury
- Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Riddhi Kundu
- Critical Care Medicine, Ruby Hall Clinic, Pune, Maharashtra, India
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Kundu R, Kapoor MC. Ultrasonography guided ventilator liberation. Ann Card Anaesth 2023; 26:245-246. [PMID: 37470521 PMCID: PMC10451136 DOI: 10.4103/aca.aca_33_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 07/21/2023] Open
Affiliation(s)
- Riddhi Kundu
- Department of Anesthesiology and Critical Care, Amrita School of Medicine and Amrita Institute of Medical Sciences, Faridabad, Haryana, India
| | - Mukul C. Kapoor
- Department of Anesthesiology and Critical Care, Amrita School of Medicine and Amrita Institute of Medical Sciences, Faridabad, Haryana, India
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Cammarota G, Vetrugno L, Longhini F. Lung ultrasound monitoring: impact on economics and outcomes. Curr Opin Anaesthesiol 2023; 36:234-239. [PMID: 36728722 DOI: 10.1097/aco.0000000000001231] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize the impact of lung ultrasonography (LUS) on economics and possible impact on patients' outcomes, proven its diagnostic accuracy in patients with acute respiratory failure. RECENT FINDINGS Despite some previous ethical concerns on LUS examination, today this technique has showed several advantages. First, it is now clear that the daily use of LUS can provide a relevant cost reduction in healthcare of patients with acute respiratory failure, while reducing the risk of transport of patients to radiological departments for chest CT scan. In addition, LUS reduces the exposition to x-rays since can replace the bedside chest X-ray examination in many cases. Indeed, LUS is characterized by a diagnostic accuracy that is even superior to portable chest X-ray when performed by well trained personnel. Finally, LUS examination is a useful tool to predict the course of patients with pneumonia, including the need for hospitalization and ICU admission, noninvasive ventilation failure and orotracheal intubation, weaning success, and mortality. SUMMARY LUS should be implemented not only in Intensive Care Units, but also in other setting like emergency departments. Since most data comes from the recent coronavirus disease 2019 pandemic, further investigations are required in Acute Respiratory Failure of different etiologies.
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Affiliation(s)
- Gianmaria Cammarota
- Anesthesia and Intensive Care Unit 2, Department of Medicine and Surgery, University of Perugia
| | - Luigi Vetrugno
- Anesthesiology, Critical Care Medicine, and Emergency, 'S.S. Annunziata' Hospital, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Gabriele d'Annunzio University of Chieti and Pescara
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, 'Mater Domini' University Hospital, Magna Graecia University, Catanzaro, Italy
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Blanco JB, Esquinas A. Commentary on "Integrated ultrasound protocol in predicting weaning success and extubation failure: a prospective observational study". Anaesthesiol Intensive Ther 2023; 55:136-137. [PMID: 37587883 PMCID: PMC10415599 DOI: 10.5114/ait.2023.129315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
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Kundu R, Subramaniam R, Baidya DK. Reply to the Commentary on "Integrated ultrasound protocol in predicting weaning success and extubation failure: a prospective observational study". Anaesthesiol Intensive Ther 2023; 55:138-139. [PMID: 37587884 PMCID: PMC10415603 DOI: 10.5114/ait.2023.129317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Affiliation(s)
- Riddhi Kundu
- Amrita Institute of Medical Sciences, Faridabad, India
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Kundu R, Srinivasan S. Diaphragmatic Rapid Shallow Breathing Index: A Simple Tool to Give more Power to Predict Weaning? Indian J Crit Care Med 2022; 26:985-986. [PMID: 36213721 PMCID: PMC9492742 DOI: 10.5005/jp-journals-10071-24318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Kundu R, Srinivasan S. Diaphragmatic Rapid Shallow Breathing Index: A Simple Tool to Give more Power to Predict Weaning? Indian J Crit Care Med 2022;26(9):985-986.
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Affiliation(s)
- Riddhi Kundu
- Department of Critical Care Medicine, Manipal Hospitals, New Delhi, India
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