Abstract
BACKGROUND: The assessment of diaphragmatic kinetics through tissue Doppler imaging (dTDI) was recently proposed as a means to describe diaphragmatic activity in both healthy individuals and intubated patients undergoing weaning from mechanical ventilation. Our primary aim was to investigate whether the diaphragmatic excursion velocity measured with dTDI at the end of a spontaneous breathing trial (SBT) was different in subjects successfully extubated versus those who passed the trial but exhibited extubation failure within 48 h after extubation.
METHODS: We enrolled 100 adult subjects, all of whom had successfully passed a 30-min SBT conducted in CPAP of 5 cm H2O. In cases of extubation failure within 48 h after liberation from invasive mechanical ventilation, subjects were re-intubated or supported through noninvasive ventilation. dTDI was performed at the end of the SBT to assess excursion, velocity, and acceleration.
RESULTS: Extubation was successful in 79 subjects, whereas it failed in 21 subjects. The median (interquartile range [IQR]) inspiratory peak excursion velocity (3.1 [IQR 2.0–4.3] vs 1.8 [1.3–2.6] cm/s, P < .001), mean velocity (1.6 [IQR 1.2–2.4] vs 1.1 [IQR 0.8–1.4] cm/s, P < .001), and acceleration (8.8 [IQR 5.0–17.8] vs 4.2 [IQR 2.4–8.0] cm/s2, P = .002) were all significantly higher in subjects who failed extubation compared with those who were successfully extubated. Similarly, the median expiratory peak relaxation velocity (2.6 [IQR 1.9–4.5] vs 1.8 [IQR 1.2–2.5] cm/s, P < .001), mean velocity (1.1 [IQR 0.7–1.7] vs 0.9 [IQR 0.6–1.0] cm/s, P = .002), and acceleration (11.2 [IQR 9.1–19.0] vs 7.1 [IQR 4.6–12.0] cm/s2, P = .004) were also higher in the subjects who failed extubation.
CONCLUSIONS: In our setting, at the end of SBT, subjects who developed extubation failure within 48 h after extubation experienced a greater diaphragmatic activation compared with subjects who were successfully extubated. (ClinicalTrials.gov registration NCT03962322.)
- diaphragm
- Doppler tissue imaging
- mechanical ventilator weaning
Footnotes
- Correspondence: Gianmaria Cammarota MD PhD, Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy. E-mail: gmcamma{at}gmail.com
Supplementary material related to this paper is available at http://www.rcjournal.com
Drs De Robertis and Vaschetto are co-first authors.
Dr Boniolo presented a version of this paper at the SIAARTI Congress, held October 16–18, 2019, in Rome, Italy.
Dr Messina has disclosed a relationship with Vygon. Dr Navalesi has disclosed relationships with Maquet Critical Care, Draeger, Intersurgical, Oriopharma, Philips, Resmed, MSD, and Novartis. Dr Navalesi also contributed to the development of the patented ‘helmet Next’, the royalties for which are paid to Intersurgical. Drs Navalesi and Longhini both contributed to the development of a device not discussed in the present study with patent application number: EP20170199831. The other authors have disclosed no conflicts of interest.
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