Using ultrasound of heart, lungs and diaphragm to predict weaning success: A prospective observational study

M E Haaksma, J Smit, B Hilderink, L Atmowihardjo, E Lim, A Jonkman, L Heunks, A Girbes, P R Tuinman

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND. In ICU patients deciding the optimal timing for extuba-tion is challenging and clinical predictors are not very accurate. Ultra-sonographic assessment of the diaphragm function has been used to predict successful extubation.1 However, cardiorespiratory function also greatly impacts a patient's ability to wean from mechanical ventilation. OBJECTIVE. To assess if a combination ultrasound measurements of the diaphragm, heart and lungs could predict extubation success more accur-ately than using single-organ ultrasonography assessment. METHODS. This prospective observational study in the Intensive Care Unit of a tertiary academic hospital included adult patients who were in-vasively ventilated for > 72 hrs. Exclusion criteria included paraplegia, tracheostomy or planned non-invasive ventilation (NIV) after extubation. Ultrasound measurements of heart (left ventricular function (LVF)), lungs (number of B-lines) and diaphragm (thickening fraction (TFdi%)) were performed within 6 hours before extubation during spontaneous breathing trial. Patients not needing reintubation or NIV within 48 hrs after extu-bation were recorded as successful extubation. A logistic regression prediction model using backward selection was made. RESULTS. In this interim analysis, 39 patients were included of which 77% were male, with a mean age of 61 (±17) years and a median of 126 [95-207] and 96 [84-185] hours on mechanical ventilation in the successful and failed group, respectively. Of these patients, 7 (18%) required reintubation within 48 hours. Patients in need of reintuba-tion compared to patients who were extubated successfully had no significant difference in TFdi% (21.2% vs. 25.5%; p=0.36), left ventricular function (72% good vs. 71% good, p=.94) or B-lines (17 [9-24] vs. 7 [3-15] p=.072), although a trend for more B-lines was observed in the extubation failure group. Multivariable regression analysis showed that addition of B-lines and classic parameters such as PaO2 and FiO2 to the thickening fraction has added value in predicting extubation (Table 1). This was not the case for LVF. CONCLUSION. The results of this study suggest that addition of lung ultrasound to diaphragm ultrasound might have added benefit in predicting extubation success, while for LVF this does not seem to be the case. Variables included: Age, Gender, Ventilation Time (VT), FiO2, PaO2, SOFA-score, Thickening fraction, BLUE-Profile, B-lines, Whitebloodcellcount, CRP, Hemoglobin (Hb), LVF, Creat, Breathing Frequency (BF), Pressure Support (PS), Tidal Volume (TV) Variables removed: Age, Gender, VT, SOFA, BLUE-Profile, WBC, CRP, Hb, LVF, BF, PS, TV N=39 Nagelkerke R2=.651 [Table Presented].
Original languageEnglish
JournalIntensive Care Medicine Experimental
Volume6
DOIs
Publication statusPublished - 2018

Cite this

@article{168f6f9593ec4329862757475bbbf1ec,
title = "Using ultrasound of heart, lungs and diaphragm to predict weaning success: A prospective observational study",
abstract = "BACKGROUND. In ICU patients deciding the optimal timing for extuba-tion is challenging and clinical predictors are not very accurate. Ultra-sonographic assessment of the diaphragm function has been used to predict successful extubation.1 However, cardiorespiratory function also greatly impacts a patient's ability to wean from mechanical ventilation. OBJECTIVE. To assess if a combination ultrasound measurements of the diaphragm, heart and lungs could predict extubation success more accur-ately than using single-organ ultrasonography assessment. METHODS. This prospective observational study in the Intensive Care Unit of a tertiary academic hospital included adult patients who were in-vasively ventilated for > 72 hrs. Exclusion criteria included paraplegia, tracheostomy or planned non-invasive ventilation (NIV) after extubation. Ultrasound measurements of heart (left ventricular function (LVF)), lungs (number of B-lines) and diaphragm (thickening fraction (TFdi{\%})) were performed within 6 hours before extubation during spontaneous breathing trial. Patients not needing reintubation or NIV within 48 hrs after extu-bation were recorded as successful extubation. A logistic regression prediction model using backward selection was made. RESULTS. In this interim analysis, 39 patients were included of which 77{\%} were male, with a mean age of 61 (±17) years and a median of 126 [95-207] and 96 [84-185] hours on mechanical ventilation in the successful and failed group, respectively. Of these patients, 7 (18{\%}) required reintubation within 48 hours. Patients in need of reintuba-tion compared to patients who were extubated successfully had no significant difference in TFdi{\%} (21.2{\%} vs. 25.5{\%}; p=0.36), left ventricular function (72{\%} good vs. 71{\%} good, p=.94) or B-lines (17 [9-24] vs. 7 [3-15] p=.072), although a trend for more B-lines was observed in the extubation failure group. Multivariable regression analysis showed that addition of B-lines and classic parameters such as PaO2 and FiO2 to the thickening fraction has added value in predicting extubation (Table 1). This was not the case for LVF. CONCLUSION. The results of this study suggest that addition of lung ultrasound to diaphragm ultrasound might have added benefit in predicting extubation success, while for LVF this does not seem to be the case. Variables included: Age, Gender, Ventilation Time (VT), FiO2, PaO2, SOFA-score, Thickening fraction, BLUE-Profile, B-lines, Whitebloodcellcount, CRP, Hemoglobin (Hb), LVF, Creat, Breathing Frequency (BF), Pressure Support (PS), Tidal Volume (TV) Variables removed: Age, Gender, VT, SOFA, BLUE-Profile, WBC, CRP, Hb, LVF, BF, PS, TV N=39 Nagelkerke R2=.651 [Table Presented].",
keywords = "9008-02-0, Embase, adult, breathing rate, clinical article, conference abstract, controlled study, diaphragm, echography, endogenous compound, extubation, female, gender, heart left ventricle function, hemoglobin, human, intensive care unit, male, middle aged, noninvasive ventilation, observational study, paraplegia, prediction, prospective study, tidal volume, tracheostomy, weaning",
author = "Haaksma, {M E} and J Smit and B Hilderink and L Atmowihardjo and E Lim and A Jonkman and L Heunks and A Girbes and Tuinman, {P R}",
year = "2018",
doi = "http://dx.doi.org/10.1186/s40635-018-0201-6",
language = "English",
volume = "6",
journal = "Intensive Care Medicine Experimental",
issn = "2197-425X",
publisher = "Springer Science + Business Media",

}

Using ultrasound of heart, lungs and diaphragm to predict weaning success: A prospective observational study. / Haaksma, M E; Smit, J; Hilderink, B; Atmowihardjo, L; Lim, E; Jonkman, A; Heunks, L; Girbes, A; Tuinman, P R.

In: Intensive Care Medicine Experimental, Vol. 6, 2018.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Using ultrasound of heart, lungs and diaphragm to predict weaning success: A prospective observational study

AU - Haaksma, M E

AU - Smit, J

AU - Hilderink, B

AU - Atmowihardjo, L

AU - Lim, E

AU - Jonkman, A

AU - Heunks, L

AU - Girbes, A

AU - Tuinman, P R

PY - 2018

Y1 - 2018

N2 - BACKGROUND. In ICU patients deciding the optimal timing for extuba-tion is challenging and clinical predictors are not very accurate. Ultra-sonographic assessment of the diaphragm function has been used to predict successful extubation.1 However, cardiorespiratory function also greatly impacts a patient's ability to wean from mechanical ventilation. OBJECTIVE. To assess if a combination ultrasound measurements of the diaphragm, heart and lungs could predict extubation success more accur-ately than using single-organ ultrasonography assessment. METHODS. This prospective observational study in the Intensive Care Unit of a tertiary academic hospital included adult patients who were in-vasively ventilated for > 72 hrs. Exclusion criteria included paraplegia, tracheostomy or planned non-invasive ventilation (NIV) after extubation. Ultrasound measurements of heart (left ventricular function (LVF)), lungs (number of B-lines) and diaphragm (thickening fraction (TFdi%)) were performed within 6 hours before extubation during spontaneous breathing trial. Patients not needing reintubation or NIV within 48 hrs after extu-bation were recorded as successful extubation. A logistic regression prediction model using backward selection was made. RESULTS. In this interim analysis, 39 patients were included of which 77% were male, with a mean age of 61 (±17) years and a median of 126 [95-207] and 96 [84-185] hours on mechanical ventilation in the successful and failed group, respectively. Of these patients, 7 (18%) required reintubation within 48 hours. Patients in need of reintuba-tion compared to patients who were extubated successfully had no significant difference in TFdi% (21.2% vs. 25.5%; p=0.36), left ventricular function (72% good vs. 71% good, p=.94) or B-lines (17 [9-24] vs. 7 [3-15] p=.072), although a trend for more B-lines was observed in the extubation failure group. Multivariable regression analysis showed that addition of B-lines and classic parameters such as PaO2 and FiO2 to the thickening fraction has added value in predicting extubation (Table 1). This was not the case for LVF. CONCLUSION. The results of this study suggest that addition of lung ultrasound to diaphragm ultrasound might have added benefit in predicting extubation success, while for LVF this does not seem to be the case. Variables included: Age, Gender, Ventilation Time (VT), FiO2, PaO2, SOFA-score, Thickening fraction, BLUE-Profile, B-lines, Whitebloodcellcount, CRP, Hemoglobin (Hb), LVF, Creat, Breathing Frequency (BF), Pressure Support (PS), Tidal Volume (TV) Variables removed: Age, Gender, VT, SOFA, BLUE-Profile, WBC, CRP, Hb, LVF, BF, PS, TV N=39 Nagelkerke R2=.651 [Table Presented].

AB - BACKGROUND. In ICU patients deciding the optimal timing for extuba-tion is challenging and clinical predictors are not very accurate. Ultra-sonographic assessment of the diaphragm function has been used to predict successful extubation.1 However, cardiorespiratory function also greatly impacts a patient's ability to wean from mechanical ventilation. OBJECTIVE. To assess if a combination ultrasound measurements of the diaphragm, heart and lungs could predict extubation success more accur-ately than using single-organ ultrasonography assessment. METHODS. This prospective observational study in the Intensive Care Unit of a tertiary academic hospital included adult patients who were in-vasively ventilated for > 72 hrs. Exclusion criteria included paraplegia, tracheostomy or planned non-invasive ventilation (NIV) after extubation. Ultrasound measurements of heart (left ventricular function (LVF)), lungs (number of B-lines) and diaphragm (thickening fraction (TFdi%)) were performed within 6 hours before extubation during spontaneous breathing trial. Patients not needing reintubation or NIV within 48 hrs after extu-bation were recorded as successful extubation. A logistic regression prediction model using backward selection was made. RESULTS. In this interim analysis, 39 patients were included of which 77% were male, with a mean age of 61 (±17) years and a median of 126 [95-207] and 96 [84-185] hours on mechanical ventilation in the successful and failed group, respectively. Of these patients, 7 (18%) required reintubation within 48 hours. Patients in need of reintuba-tion compared to patients who were extubated successfully had no significant difference in TFdi% (21.2% vs. 25.5%; p=0.36), left ventricular function (72% good vs. 71% good, p=.94) or B-lines (17 [9-24] vs. 7 [3-15] p=.072), although a trend for more B-lines was observed in the extubation failure group. Multivariable regression analysis showed that addition of B-lines and classic parameters such as PaO2 and FiO2 to the thickening fraction has added value in predicting extubation (Table 1). This was not the case for LVF. CONCLUSION. The results of this study suggest that addition of lung ultrasound to diaphragm ultrasound might have added benefit in predicting extubation success, while for LVF this does not seem to be the case. Variables included: Age, Gender, Ventilation Time (VT), FiO2, PaO2, SOFA-score, Thickening fraction, BLUE-Profile, B-lines, Whitebloodcellcount, CRP, Hemoglobin (Hb), LVF, Creat, Breathing Frequency (BF), Pressure Support (PS), Tidal Volume (TV) Variables removed: Age, Gender, VT, SOFA, BLUE-Profile, WBC, CRP, Hb, LVF, BF, PS, TV N=39 Nagelkerke R2=.651 [Table Presented].

KW - 9008-02-0

KW - Embase

KW - adult

KW - breathing rate

KW - clinical article

KW - conference abstract

KW - controlled study

KW - diaphragm

KW - echography

KW - endogenous compound

KW - extubation

KW - female

KW - gender

KW - heart left ventricle function

KW - hemoglobin

KW - human

KW - intensive care unit

KW - male

KW - middle aged

KW - noninvasive ventilation

KW - observational study

KW - paraplegia

KW - prediction

KW - prospective study

KW - tidal volume

KW - tracheostomy

KW - weaning

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UR - http://www.mendeley.com/research/using-ultrasound-heart-lungs-diaphragm-predict-weaning-success-prospective-observational-study

U2 - http://dx.doi.org/10.1186/s40635-018-0201-6

DO - http://dx.doi.org/10.1186/s40635-018-0201-6

M3 - Article

VL - 6

JO - Intensive Care Medicine Experimental

JF - Intensive Care Medicine Experimental

SN - 2197-425X

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