RT Journal Article
SR Electronic
T1 Association of Diaphragm Movement During Cough, as Assessed by Ultrasonography, With Extubation Outcome
JF Respiratory Care
FD American Association for Respiratory Care
SP 1713
OP 1719
DO 10.4187/respcare.09007
VO 66
IS 11
A1 Norisue, Yasuhiro
A1 Santanda, Takushi
A1 Nabeshima, Tadanori
A1 Tomita, Shizuka
A1 Saito, Shinjiro
A1 Kataoka, Jun
A1 Fujimoto, Yoshihisa
A1 Tokuda, Yasuharu
A1 Homma, Yosuke
A1 Fujitani, Shigeki
YR 2021
UL http://rc.rcjournal.com/content/66/11/1713.abstract
AB BACKGROUND: A cough peak flow (CPF) of < 60 L/min was associated with increased risk of extubation failure after a successful spontaneous breathing trial (SBT). Passive cephalic excursion of the diaphragm (PCED), measured by ultrasonography during cough expiration, was reported to predict CPF in healthy adults. We hypothesized that PCED, diaphragm peak velocity, or both during cough, as measured by ultrasonography, might predict CPF and extubation outcomes in mechanically ventilated patients. This study attempted to identify associations of diaphragm movement during cough, as assessed by ultrasonography with simultaneously measured CPF, and to determine predictive values of ultrasonographic indices for extubation outcomes after a successful SBT.METHODS: In the study, 252 mechanically ventilated subjects with a successful SBT were enrolled in a prospective cohort study. Right hemidiaphragm passive cephalic excursion and peak velocity were measured by ultrasonography during voluntary cough expiration with maximum effort. CPF was measured simultaneously by ultrasonography.RESULTS: A multiple regression model adjusted for age and sex showed a significant association between PCED and CPF (P < .001, adjusted β coefficient 11.4, 95% CI 8.88–14.0, adjusted R2 = 0.287) and between diaphragm peak velocity and CPF (P < .001, adjusted β coefficient 1.71, 95% CI 1.91–2.24, adjusted R2 = 0.235). The areas under the curves of PCED, diaphragm peak velocity, and CPF for extubation failure were 0.791 (95% Cl 0.668–0.914), 0.587 (95% Cl 0.426–0.748), and 0.765 (95% Cl 0.609–0.922), respectively.CONCLUSIONS: PCED on ultrasonography was significantly associated with CPF and extubation failure after a successful SBT. Future studies should investigate if this method is applicable for determination of tracheostomy decannulation in stable patients in general wards.