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Research ArticleOriginal Research

Extubation Failure Prediction by Echography of the Diaphragm After Cardiothoracic Surgery: The EXPEDIA Study

Thibaut Genty, Florent Laverdure, Olivier Peyrouset, Saïda Rezaiguia-Delclaux, Jacques Thès and François Stéphan
Respiratory Care March 2022, 67 (3) 308-315; DOI: https://doi.org/10.4187/respcare.09476
Thibaut Genty
Department of Anesthesiology and Intensive Care, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Paris, France.
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  • For correspondence: [email protected]
Florent Laverdure
Department of Anesthesiology and Intensive Care, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Paris, France.
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Olivier Peyrouset
Department of Anesthesiology and Intensive Care, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Paris, France.
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Saïda Rezaiguia-Delclaux
Department of Anesthesiology and Intensive Care, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Paris, France.
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Jacques Thès
Department of Anesthesiology and Intensive Care, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Paris, France.
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François Stéphan
Department of Anesthesiology and Intensive Care, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Paris, France and University Paris Saclay Faculty of Medicine, Kremlin Bicêtre, France.
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Abstract

BACKGROUND: Successful extubation is difficult to predict. Ultrasound measurement of the diaphragm thickening fraction (DTF) might help predict weaning failure after cardiothoracic surgery.

METHODS: We assessed the predictive performance of diaphragm ultrasound in a derivation cohort of 50 prospectively included cardiothoracic surgery subjects ready for a weaning trial and in a validation cohort of 39 subjects ventilated for ≥ 48 h. DTF was assessed by ultrasound during pressure support ventilation (PSV) then during a T-piece spontaneous breathing trial (SBT). DTF was the percentage change in diaphragm thickness between expiration and inspiration and DTFmax, the higher DTF value of the 2 hemidiaphragms. DTFmax during SBT (static study) and the difference in DTFmax between PSV and SBT (dynamic study) were analyzed.

RESULTS: In the derivation cohort, DTFmax during SBT was 25.6 ± 17.3% in subjects with successful extubation and 65.2 ± 17.3% in those with weaning failure (difference 39.7 [95% CI 27.4–51.9], P < .01). During SBT, DTFmax ≥ 50% was associated with weaning failure (area under the receiver operating characteristic curve [AUC] 0.94 ± 0.05). In the dynamic study, a ≥ 40% DTFmax increase was associated with weaning failure (AUC 0.91 ± 0.06). In the validation cohort, DTFmax during SBT was 20.3 ± 17.1% in subjects with successful extubation and 82.0 ± 51.6% in those with weaning failure (difference 61.8 [95% CI 41.6–82.0], P < .01). During SBT, DTFmax ≥ 50% predicted weaning failure (AUC 0.99 ± 0.02). In the dynamic study, a ≥ 40% increase in DTFmax predicted weaning failure (AUC 0.81 ± 0.09).

CONCLUSIONS: Measuring DTFmax during SBT and the DTFmax change when switching from PSV to SBT may help predict weaning failure after cardiothoracic surgery. The study was registered on ANZCTR. Clinical trial registration number: U1111-1180-1999.

  • weaning
  • mechanical ventilation
  • diaphragm ultrasound
  • cardiothoracic surgery

Footnotes

  • Correspondence: Thibaut Genty MD, Department of Anesthesiology and Intensive Care, Marie Lannelongue Hospital, 133 avenue de la Résistance, 92350 Le Plessis Robinson, Groupe Hospitalier Paris Saint Joseph, Paris, France. E-mail: t.genty{at}ghpsj.fr
  • The authors have disclosed no conflicts of interest.

  • The study was supported solely by institutional sources.

  • Supplemental material related to this paper is available at http://rc.rcjournal.com.

  • Copyright © 2022 by Daedalus Enterprises
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Respiratory Care: 67 (3)
Respiratory Care
Vol. 67, Issue 3
1 Mar 2022
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Extubation Failure Prediction by Echography of the Diaphragm After Cardiothoracic Surgery: The EXPEDIA Study
Thibaut Genty, Florent Laverdure, Olivier Peyrouset, Saïda Rezaiguia-Delclaux, Jacques Thès, François Stéphan
Respiratory Care Mar 2022, 67 (3) 308-315; DOI: 10.4187/respcare.09476

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Extubation Failure Prediction by Echography of the Diaphragm After Cardiothoracic Surgery: The EXPEDIA Study
Thibaut Genty, Florent Laverdure, Olivier Peyrouset, Saïda Rezaiguia-Delclaux, Jacques Thès, François Stéphan
Respiratory Care Mar 2022, 67 (3) 308-315; DOI: 10.4187/respcare.09476
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Keywords

  • weaning
  • mechanical ventilation
  • diaphragm ultrasound
  • cardiothoracic surgery

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