TY - JOUR
T1 - Diaphragmatic Kinetics Assessment by Tissue Doppler Imaging and Extubation Outcome
AU - Cammarota, Gianmaria
AU - Boniolo, Ester
AU - Santangelo, Erminio
AU - De Vita, Nello
AU - Verdina, Federico
AU - Crudo, Samuele
AU - Sguazzotti, Ilaria
AU - Perucca, Raffaella
AU - Messina, Antonio
AU - Zanoni, Marta
AU - Azzolina, Danila
AU - Navalesi, Paolo
AU - Longhini, Federico
AU - Vetrugno, Luigi
AU - Bignami, Elena
AU - Corte, Francesco della
AU - Tarquini, Riccardo
AU - De Robertis, Edoardo
AU - Vaschetto, Rosanna
N1 - Publisher Copyright:
© 2021 Daedalus Enterprises.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - 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 inves-tigate 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.).
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 inves-tigate 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.).
KW - Doppler tissue imaging
KW - diaphragm
KW - mechanical ventilator weaning
UR - https://www.scopus.com/pages/publications/85107090929
U2 - 10.4187/respcare.08702
DO - 10.4187/respcare.08702
M3 - Article
SN - 0020-1324
VL - 66
SP - 983
EP - 993
JO - Respiratory Care
JF - Respiratory Care
IS - 6
ER -