Value of Combination of Heart, Lung, and Diaphragm Ultrasound in Predicting Weaning Outcome of Mechanical Ventilation
Xia Xu, Rong Wu, Ya-jiang Zhang, Hui-wen Li, Xiu-hong He, Shu-min Wang
Department of Ultrasound, Ordos Central Hospital, Ordos, Inner Mongolia, China (mainland)
Med Sci Monit 2020; 26:e924885
Available online: 2020-06-12
Postextubation distress is detrimental to the prognosis of critically ill patients with successful spontaneous breathing trial. The known risk factors of failed weaning are associated with the heart, lungs, and diaphragm. The aim of this study was to explore the role of a combined model including indicators of heart, lung, and diaphragm ultrasound in predicting the weaning outcome.
MATERIAL AND METHODS: Patients’ clinical data and ultrasonic features of heart, lungs, and diaphragm were recorded. Patients were included in either the failed weaning group (n=24) or the successful weaning group (n=81). The association of potential variables with the risk of weaning failure was determined using multivariate logistic regression analysis. The accuracy of potential indicators for predicting the weaning outcome were evaluated and a multiindicator combined model was established to improve the predictive accuracy.
RESULTS: Brain natriuretic peptide (odds ratio [OR]=1.120, P=0.004), left-atrial pressure (LAP) (OR=1.333, P=0.005), lung ultrasound score (LUS) (OR=1.736, P=0.001), and hemidiaphragm dysfunction (OR=3.942, P=0.014) were associated with an increased risk of weaning failure. However, all of these indicators could not accurately predict the weaning outcome independently (all areas under the curve [AUCs] <0.9). The combination of LAP, LUS, and hemidiaphragm dysfunction showed the highest AUC (AUC=0.919).
CONCLUSIONS: The combined model including LAP, LUS, and hemidiaphragm dysfunction were the most accurate method for the prediction.
Keywords: Echocardiography, Respiration, Artificial, Ventilator Weaning