Lung and diaphragm ultrasound as predictors of success in weaning from mechanical ventilation

Background: Lung and diaphragm ultrasound methods have recently been introduced to predict the outcome of weaning from mechanical ventilation (MV). The aim of this study is to assess the reliability and accuracy of these techniques for predicting successful weaning in critically ill adults. Methods:...

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Autores: Tenza-Lozano E, Llamas-Alvarez A, Jaimez-Navarro E, FERNANDEZ, F.
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2018
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p5116
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/5116
Access Level:acceso abierto
Palabra clave:Lung ultrasound
Diaphragm ultrasound
Weaning
Withdrawal of mechanical ventilation
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spelling Lung and diaphragm ultrasound as predictors of success in weaning from mechanical ventilationTenza-Lozano ELlamas-Alvarez AJaimez-Navarro EFERNANDEZ, F.Lung ultrasoundDiaphragm ultrasoundWeaningWithdrawal of mechanical ventilationBackground: Lung and diaphragm ultrasound methods have recently been introduced to predict the outcome of weaning from mechanical ventilation (MV). The aim of this study is to assess the reliability and accuracy of these techniques for predicting successful weaning in critically ill adults. Methods: We conducted two studies: a cross-sectional interobserver agreement study between two sonographers and a prospective cohort study to assess the accuracy of lung and diaphragm ultrasound for predicting weaning and extubation outcome. For the interobserver agreement study, we included 50 general critical care patients who were consecutively admitted to the ICU. For the predictive accuracy study, we included consecutively 69 patients on MV who were ready for weaning. We assessed interobserver agreement of ultrasound measurements, using the weighted kappa coefficient for LUSm score (modified lung ultrasound score) and the intraclass correlation coefficient (ICC) and Bland-Altman method for TI (diaphragm thickening index). We assessed the predictive value of LUSm and TI in weaning outcome by plotting the corresponding ROC curves. Results: We found adeguate interobserver agreement for both LUSm (weighted kappa 0.95) and TI (ICC 0.78, difference according to Bland-Altman analysis +/- 12.5%). LUSm showed good-moderate discriminative power for successful weaning and extubation (area under the ROC curve (AUC) for successful weaning 0.80, and sensitivity and specificity at optimal cut-off point 0.76 and 0.73, respectively; AUC for successful extubation 0.78, and optimal sensitivity and specificity 0.76 and 0.47, respectively. TI was more sensitive but less specific for predicting successful weaning (AUC 0.71, optimal sensitivity and specificity 0.93 and 0.48) and successful extubation (AUC 0.76, optimal sensitivity and specificity 0.93 and 0.58). The area under the ROC curve for predicting weaning success was 0.83 for both ultrasound measurements together. Conclusions: Interobserver agreement was excellent for LUSm and moderate-good for TI. A low TI value or high LUSm value indicates high risk of weaning failure.SPRINGEROPEN2018info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fisabio.portalinvestigacion.com/publicaciones/5116Critical Ultrasound JournalISSN: 20363176ISSNe: 20367902reponame:r-FISABIO. Repositorio Institucional de Producción Científicainstname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)Inglésinfo:eu-repo/semantics/openAccessoai:fisabio.fundanetsuite.com:p51162026-06-11T12:45:17Z
dc.title.none.fl_str_mv Lung and diaphragm ultrasound as predictors of success in weaning from mechanical ventilation
title Lung and diaphragm ultrasound as predictors of success in weaning from mechanical ventilation
spellingShingle Lung and diaphragm ultrasound as predictors of success in weaning from mechanical ventilation
Tenza-Lozano E
Lung ultrasound
Diaphragm ultrasound
Weaning
Withdrawal of mechanical ventilation
title_short Lung and diaphragm ultrasound as predictors of success in weaning from mechanical ventilation
title_full Lung and diaphragm ultrasound as predictors of success in weaning from mechanical ventilation
title_fullStr Lung and diaphragm ultrasound as predictors of success in weaning from mechanical ventilation
title_full_unstemmed Lung and diaphragm ultrasound as predictors of success in weaning from mechanical ventilation
title_sort Lung and diaphragm ultrasound as predictors of success in weaning from mechanical ventilation
dc.creator.none.fl_str_mv Tenza-Lozano E
Llamas-Alvarez A
Jaimez-Navarro E
FERNANDEZ, F.
author Tenza-Lozano E
author_facet Tenza-Lozano E
Llamas-Alvarez A
Jaimez-Navarro E
FERNANDEZ, F.
author_role author
author2 Llamas-Alvarez A
Jaimez-Navarro E
FERNANDEZ, F.
author2_role author
author
author
dc.subject.none.fl_str_mv Lung ultrasound
Diaphragm ultrasound
Weaning
Withdrawal of mechanical ventilation
topic Lung ultrasound
Diaphragm ultrasound
Weaning
Withdrawal of mechanical ventilation
description Background: Lung and diaphragm ultrasound methods have recently been introduced to predict the outcome of weaning from mechanical ventilation (MV). The aim of this study is to assess the reliability and accuracy of these techniques for predicting successful weaning in critically ill adults. Methods: We conducted two studies: a cross-sectional interobserver agreement study between two sonographers and a prospective cohort study to assess the accuracy of lung and diaphragm ultrasound for predicting weaning and extubation outcome. For the interobserver agreement study, we included 50 general critical care patients who were consecutively admitted to the ICU. For the predictive accuracy study, we included consecutively 69 patients on MV who were ready for weaning. We assessed interobserver agreement of ultrasound measurements, using the weighted kappa coefficient for LUSm score (modified lung ultrasound score) and the intraclass correlation coefficient (ICC) and Bland-Altman method for TI (diaphragm thickening index). We assessed the predictive value of LUSm and TI in weaning outcome by plotting the corresponding ROC curves. Results: We found adeguate interobserver agreement for both LUSm (weighted kappa 0.95) and TI (ICC 0.78, difference according to Bland-Altman analysis +/- 12.5%). LUSm showed good-moderate discriminative power for successful weaning and extubation (area under the ROC curve (AUC) for successful weaning 0.80, and sensitivity and specificity at optimal cut-off point 0.76 and 0.73, respectively; AUC for successful extubation 0.78, and optimal sensitivity and specificity 0.76 and 0.47, respectively. TI was more sensitive but less specific for predicting successful weaning (AUC 0.71, optimal sensitivity and specificity 0.93 and 0.48) and successful extubation (AUC 0.76, optimal sensitivity and specificity 0.93 and 0.58). The area under the ROC curve for predicting weaning success was 0.83 for both ultrasound measurements together. Conclusions: Interobserver agreement was excellent for LUSm and moderate-good for TI. A low TI value or high LUSm value indicates high risk of weaning failure.
publishDate 2018
dc.date.none.fl_str_mv 2018
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fisabio.portalinvestigacion.com/publicaciones/5116
url https://fisabio.portalinvestigacion.com/publicaciones/5116
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv SPRINGEROPEN
publisher.none.fl_str_mv SPRINGEROPEN
dc.source.none.fl_str_mv Critical Ultrasound Journal
ISSN: 20363176
ISSNe: 20367902
reponame:r-FISABIO. Repositorio Institucional de Producción Científica
instname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
instname_str Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
reponame_str r-FISABIO. Repositorio Institucional de Producción Científica
collection r-FISABIO. Repositorio Institucional de Producción Científica
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