RT Journal Article
SR Electronic
T1 Diaphragmatic Kinetics Assessment by Tissue Doppler Imaging and Extubation Outcome
JF Respiratory Care
FD American Association for Respiratory Care
SP 983
OP 993
DO 10.4187/respcare.08702
VO 66
IS 6
A1 Cammarota, Gianmaria
A1 Boniolo, Ester
A1 Santangelo, Erminio
A1 De Vita, Nello
A1 Verdina, Federico
A1 Crudo, Samuele
A1 Sguazzotti, Ilaria
A1 Perucca, Raffaella
A1 Messina, Antonio
A1 Zanoni, Marta
A1 Azzolina, Danila
A1 Navalesi, Paolo
A1 Longhini, Federico
A1 Vetrugno, Luigi
A1 Bignami, Elena
A1 della Corte, Francesco
A1 Tarquini, Riccardo
A1 De Robertis, Edoardo
A1 Vaschetto, Rosanna
YR 2021
UL http://rc.rcjournal.com/content/66/6/983.abstract
AB 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.)