The power of diaphragm ultrasonography in predicting weaning success

Yıl 2022, Cilt: 47 Sayı: 2, 747 - 755, 30.06.2022

Mine Altınkaya Çavuş Şerife Gökbulut Bektaş Hilal Sipahioğlu Gözde Ertürk Zararsız Sema Turan

https://doi.org/10.17826/cumj.1037159

Cited By: 1

Öz

Purpose: The aim of this study; to evaluate the effects of diaphragm thickness on weaning with ultrasonography (USG).
Materials and Methods: In this prospective study; demographic characteristics of the patients, indications for hospitalization in the intensive care unit and mechanical ventilation, comorbidity, diaphragm thickness, Sequential Organ Failure Assessment (SOFA) score and Simplified Acute Physiology Score (SAPS) II, mortality rate, peripheral oxygen saturation (SpO2), invasive mechanical ventilator (IMV) duration, minute volume, respiratory rate (RR), expiratory volumes (VTE), RSBI values were recorded. The patients were ventilated spontaneously for 30 minutes in pressure support (PS) mode in IMV. Diaphragm thickness (DT) was measured using a 7-10 MHz linear ultrasound probe set to B mode. The right hemidiaphragm was visualized in the midaxillary line between the 8th and 10th intercostal spaces, at the junction of the diaphragm and rib cage. After the measurements were stabilized, the patients were taken to the T-tube for one hour. The patients who successfully completed T-tube spontaneous breathing trials (SBT) were extubated. The patients were divided into two groups as successful and unsuccessful weaning.
Results: A total of 72 patients were evaluated by meeting the inclusion criteria. Four of the patients were excluded from the study because they received IMV support for less than 24 hours. There was no difference between the groups in the ratios of diaphragm thickness index (DTI) and diaphragmatic thickening fraction (DTF). The thickness measurements of the diaphragm, defined as diaphragm thickness at the end of inspiration (DTV) and diaphragm thickness at the end of expiration (DFRV), were higher in the successful weaning group. The best threshold value of DTV to predict weaning success was found to be 0.72 and DFRV value to be 0.669.
Conclusion: Weaning success is closely related to diaphragm functions, diaphragm thickness parameters and lung capacities. USG is a practical, bedside, noninvasive method that can be used to evaluate the diaphragm. DTV and DFRV are among the parameters that can predict success in the weaning process. DTF and DTI were found to be insufficient in predicting weaning success.

Anahtar Kelimeler

Diaphragmatic thickening fraction (DTF), Ultrasonography, RSBI (rapid shallow breathing index), Weaning, Intensive care.

Diyafram ultrasonografisinin weaning başarısını tahmin etmedeki gücü

Öz

Amaç: Bu çalışmada amaç; diyafram kalınlığının weaning üzerine etkilerini ultrasonografi (USG) ile değerlendirmektir.
Gereç ve Yöntem: Prospektif olarak yapılan bu çalışmada; hastaların demografik özellikleri, yoğun bakıma yatış ve mekanik ventilasyon endikasyonları, ek hastalıkları, diyafram kalınlığı, Sıralı Organ Yetmezliği Değerlendirmesi (SOFA) skoru ve Basitleştirilmiş Akut Fizyoloji Skoru (SAPS) II, mortalite oranı, periferik oksijen satürasyonu (SpO2), IMV süresi, dakika hacmi, solunum sayısı (RR), ekspiratuar hacimleri, RSBI değerleri kaydedildi.Hastalar invaziv mekanik ventilatör (IMV) basınç desteği (PS) modunda 30 dakika boyunca spontan olarak ventile edildi . Diyafram kalınlığı (DT), B moduna ayarlanmış 7-10 MHz lineer ultrason probu kullanılarak ölçüldü. Sağ hemidiyafram, 8. ve 10. interkostal boşluklar arasındaki midaksiller çizgide diyafram ve göğüs kafesinin birleştiği bölgede görüntülendi. Ölçümler sonrasında hastalar stabil hale geldikten sonra 1 saat boyunca T-tüpe alındı. T-tüpte spontan solunum denemeleri (SBT)'ni başarıyla tamamlayan hastalar ekstübe edildi. Hastalar başarılı ve başarısız weaning olmak üzere 2 gruba ayrıldı.
Bulgular: Toplam 72 hasta çalışmaya dahil edilme kriterlerini sağlayarak değerlendirilmeye alındı. Hastaların 4 tanesi 24 saatten daha kısa süre IMV desteği aldığı için çalışma dışı bırakıldı. Diyafram kalınlık indeksi (DTI) ve diyafram kalınlaşma fraksiyonu (DTF) oranlarında gruplar arasında bir farklılık gözlenmedi. İnspirasyon sonunu diyafram kalınlığı (DTV) ve ekspirasyon sonunu diyafram kalınlığı (DFRV) olarak tanımlanan diyaframın kalınlık ölçümleri başarılı weaning grubunda daha yüksekti. Weaning başarısını tahmin etmek için DTV'nin en iyi eşik değeri 0.72, DFRV değeri 0.669 olarak bulundu.
Sonuç: Weaning başarısı diyafram fonksiyonları, diyafram kalınlık parametreleri ve akciğer kapasiteleri ile yakından ilişkilidir. USG, diyaframı değerlendirmek için kullanılabilecek pratik, hasta başı uygulanabilen, noninvaziv bir yöntemdir. DTV ve DFRV weaning sürecinde başarıyı tahmin edebilecek parametreler arasındadır. DTF ve DTI weaning başarısını öngörmede yetersiz bulundu.

Anahtar Kelimeler

Diyafragmatik kalınlaşma fraksiyonu (DTF), Ultrasonografi, RSBI (hızlı sığ solunum indeksi), Weaning, Yoğun bakım.

Kaynakça

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