RT Journal Article SR Electronic T1 Holistic Ultrasound to Predict Extubation Failure in Clinical Practice JF Respiratory Care FD American Association for Respiratory Care SP 994 OP 1003 DO 10.4187/respcare.08679 VO 66 IS 6 A1 Mark E Haaksma A1 Jasper M Smit A1 Micah LA Heldeweg A1 Jip S Nooitgedacht A1 Leila N Atmowihardjo A1 Annemijn H Jonkman A1 Heder J de Vries A1 Endry HT Lim A1 Thei Steenvoorden A1 Erik Lust A1 Armand RJ Girbes A1 Leo MA Heunks A1 Pieter R Tuinman YR 2021 UL http://rc.rcjournal.com/content/66/6/994.abstract AB BACKGROUND: A weaning trial can be considered a stress test of the cardiorespiratory system; it increases oxygen demand and thus warrants a higher cardiac index and elevated breathing effort. We hypothesized that the combination of easily performed ultrasound measurements of heart, lungs, and diaphragm would yield good diagnostic accuracy to predict extubation failure.METHODS: Adult subjects ventilated for > 72 h with a successful spontaneous breathing trial were included. Ultrasound measurements of heart (left ventricular function), lungs (number of B-lines), and diaphragm thickening fraction were performed during a spontaneous breathing trial. The primary outcomes were sensitivity, specificity, and area under the receiver operating characteristic curve of a holistic ultrasound approach for extubation failure. Re-intubation within 48 h was considered extubation failure.RESULTS: Eighty-three subjects were included, of whom 15 (18%) were re-intubated within 48 h. The sensitivity and specificity of a holistic approach were 100% (78.2–100%) and 7.7% (2.5–17.1%), respectively, with an area under the receiver operating characteristic curve of 0.54. The sensitivity and specificity of diaphragm thickening fraction, using a cutoff value of < 30% for extubation failure were 86.7% (59.5–98.3%) and 25.4% (15.5–37.5%), respectively, with an area under the receiver operating characteristic curve of 0.61.CONCLUSIONS: In subjects ventilated for > 72 h who had a successful spontaneous breathing trial, holistic ultrasound was a weak predictor for extubation failure. (ClinicalTrials.gov registration NCT04196361).