Ultrasound evaluation of cardiac and diaphragmatic function at different positions during a spontaneous breathing trial predicting extubation outcomes: a retrospective cohort study.

IF 2.9 3区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING BMC Medical Imaging Pub Date : 2024-08-15 DOI:10.1186/s12880-024-01357-7
Ling Luo, Yidan Li, Lifang Wang, Bing Sun, Zhaohui Tong
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Abstract

Background: The ratio (E/Ea) of mitral Doppler inflow velocity to annular tissue Doppler wave velocity by transthoracic echocardiography and diaphragmatic excursion (DE) by diaphragm ultrasound have been confirmed to predict extubation outcomes. However, few studies focused on the predicting value of E/Ea and DE at different positions during a spontaneous breathing trial (SBT), as well as the effects of △E/Ea and △DE (changes in E/Ea and DE during a SBT).

Methods: This study was a reanalysis of the data of 60 difficult-to-wean patients in a previous study published in 2017. All eligible participants were organized into respiratory failure (RF) group and extubation success (ES) group within 48 h after extubation, or re-intubation (RI) group and non-intubation (NI) group within 1 week after extubation. The risk factors for respiratory failure and re-intubation including E/Ea and △E/Ea, DE and △DE at different positions were analyzed by multivariate logistic regression, respectively. The receiver operating characteristic (ROC) curves of E/Ea (septal, lateral, average) and DE (right, left, average) were compared with each other, respectively.

Results: Of the 60 patients, 29 cases developed respiratory failure within 48 h, and 14 of those cases required re-intubation within 1 week. Multivariate logistic regression showed that E/Ea were all associated with respiratory failure, while only DE (right) and DE (average) after SBT were related to re-intubation. There were no statistic differences among the ROC curves of E/Ea at different positions, nor between the ROC curves of DE. No statistical differences were shown in △E/Ea between RF and ES groups, while △DE (average) was remarkably higher in NI group than that in RI group. However, multivariate logistic regression analysis showed that △DE (average) was not associated with re-intubation.

Conclusions: E/Ea at different positions during a SBT could predict postextubation respiratory failure with no statistical differences among them. Likewise, only DE (right) and DE (average) after SBT might predict re-intubation with no statistical differences between each other.

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通过超声波评估自主呼吸试验中不同体位的心脏和横膈膜功能,预测拔管结果:一项回顾性队列研究。
背景:经胸超声心动图显示的二尖瓣多普勒血流速度与瓣环组织多普勒波速度之比(E/Ea)和膈肌超声显示的膈肌偏移(DE)已被证实可预测拔管结果。然而,很少有研究关注自主呼吸试验(SBT)期间不同体位下 E/Ea 和 DE 的预测价值,以及△E/Ea 和 △DE(自主呼吸试验期间 E/Ea 和 DE 的变化)的影响:本研究重新分析了2017年发表的一项研究中60名难断奶患者的数据。所有符合条件的参与者在拔管后 48 小时内分为呼吸衰竭(RF)组和拔管成功(ES)组,或在拔管后 1 周内分为再次插管(RI)组和未插管(NI)组。通过多变量逻辑回归分析了呼吸衰竭和再次插管的风险因素,包括不同体位的 E/Ea 和 △E/Ea、DE 和 △DE。分别比较了E/Ea(室间隔、侧壁、平均值)和DE(右侧、左侧、平均值)的接收者操作特征曲线(ROC):在 60 例患者中,29 例在 48 小时内出现呼吸衰竭,其中 14 例在 1 周内需要再次插管。多变量逻辑回归显示,E/Ea均与呼吸衰竭有关,而只有SBT后的DE(右侧)和DE(平均值)与再次插管有关。不同位置 E/Ea 的 ROC 曲线之间以及 DE 的 ROC 曲线之间没有统计学差异。RF 组和 ES 组之间的△E/Ea 没有统计学差异,而 NI 组的△DE(平均值)明显高于 RI 组。然而,多变量逻辑回归分析表明,△DE(平均值)与再次插管无关:结论:SBT 过程中不同体位的 E/Ea 均可预测拔管后呼吸衰竭,但两者之间无统计学差异。同样,只有 SBT 后的 DE(右侧)和 DE(平均值)可预测再次插管,但两者之间没有统计学差异。
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来源期刊
BMC Medical Imaging
BMC Medical Imaging RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
4.60
自引率
3.70%
发文量
198
审稿时长
27 weeks
期刊介绍: BMC Medical Imaging is an open access journal publishing original peer-reviewed research articles in the development, evaluation, and use of imaging techniques and image processing tools to diagnose and manage disease.
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