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2026, Number 1

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Med Crit 2026; 40 (1)

Ultrasound of intercostal muscles: a tool to predict outcomes in extubation of the critically ill patient

Celestino LJM, Pinedo LM, Vázquez RR

Language: Spanish
References: 16
Page: 43-48
PDF size: 306.56 Kb.


ABSTRACT

Introduction: timely weaning from mechanical ventilation is essential to reduce complications. Predicting success using ultrasound is a simple and noninvasive tool. It has been observed that a thickening fraction of the parasternal intercostal muscle greater than 10% predicts extubation failure. Objective: to determine whether a paraesternal intercostal muscle thickening fraction of less than 10% predicts successful extubation. Material and methods: observational, analytical, longitudinal and prospective study with patients over 18 years of age with invasive mechanical ventilation for more than 24 hours. Ultrasound of the intercostal muscle was performed, and descriptive and inferential analysis was applied with binary logistic regression. Results: 87 patients were included. Successful extubation was observed in 90.8% of patients. The mean value of the thickening fraction of the intercostal muscles was 10 ± 2.3 (%). The mean value of patients who had successful extubation was 9.85 ± 2.2 and the mean value of patients who had failed extubation was 12.5 ± 1.6. Conclusions: patients with values greater than 10% of the intercostal muscle thickening fraction have less probability of successful extubation.


REFERENCES

  1. Hernández-López GD, Cerón-Juárez R, Escobar-Ortiz D, Graciano-Gaytán L, Gorordo-Delsol LA, Merinos-Sánchez G, et al. Retiro de la ventilación mecánica. Med Crít (Col Mex Med Crít). 2017;31(4):238-245. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2448-89092017000400238&lng=esta

  2. MacIntyre NR, Epstein SK, Carson S, Scheinhorn D, Christopher K, Muldoon S et al. Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference. Chest. 2005;128(6):3937-3954. Available in: https://journal.chestnet.org/article/S0012-3692(15)49639-4/abstract. https://doi.org/10.1378/chest.128.6.3937

  3. Pham T, Brochard LJ, Slutsky AS. Mechanical ventilation: state of the art. Mayo Clin Proc. 2017;92(9):1382-1400. doi: 10.1016/j.mayocp.2017.05.004.

  4. Nevins ML, Epstein SK. Weaning from prolonged mechanical ventilation. Clin Chest Med. 2001;22(1):13-33.

  5. Thille AW, Richard JC, Brochard L. The decision to extubate in the intensive care unit. Am J Respir Crit Care Med. 2013;187(12):1294-1302.

  6. Saeed F, Lasrado S. Extubation [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Feb 19]. Available in: https://www.ncbi.nlm.nih.gov/books/NBK539804/#

  7. Béduneau G, Pham T, Schortgen F, Piquilloud L, Zogheib E, Jonas M, et al. Epidemiology of weaning outcome according to a new definition. The WIND Study. Am J Respir Crit Care Med. 2017;195(6):772-783.

  8. Formenti P, Umbrello M, Dres M, Chiumello D. Ultrasonographic assessment of parasternal intercostal muscles during mechanical ventilation. Ann Intensive Care. 2020;10(1):120.

  9. Vivier E, Muller M, Putegnat JB, Steyer J, Barrau S, Boissier F, et al. Inability of diaphragm ultrasound to predict extubation failure: a multicenter study. Chest. 2019;155(6):1131-1139. Available in: https://journal.chestnet.org/article/S0012-3692(19)30694-4/fulltext

  10. Raper AJ, Thompson WT Jr, Shapiro W, Patterson JL Jr. Scalene and sternomastoid muscle function. J Appl Physiol. 1966;21(2):497-502.

  11. De Troyer A, Legrand A, Gevenois PA, Wilson TA. Mechanical advantage of the human parasternal intercostal and triangularis sterni muscles. J Physiol. 1998;513(Pt 3)(Pt 3):915-925.

  12. Yoshida R, Tomita K, Kawamura K, Nozaki T, Setaka Y, Monma M, et al. Measurement of intercostal muscle thickness with ultrasound imaging during maximal breathing. J Phys Ther Sci. 2019;31(4):340-343.

  13. Umbrello M, Formenti P, Lusardi AC, Guanziroli M, Caccioppola A, Coppola S, et al. Oesophageal pressure and respiratory muscle ultrasonographic measurements indicate inspiratory effort during pressure support ventilation. Br J Anaesth. 2020;125(1):e148-e157. Available in: https://www.sciencedirect.com/science/article/pii/S0007091220302014

  14. Reyes A, López S, Vidal E, Cerón U. Fracción de engrosamiento de músculos paraesternales intercostales y engrosamiento diafragmático como predictores de fracaso de la prueba de ventilación espontánea. Med crit. 2023;37(7):600-604. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2448-89092023000700600&lng=es.Epub 13-Ene-2025. https://doi.org/10.35366/114862.

  15. Peng L, Kang H, Chang H, Sun Y, Zhao Y, Zhao H. The ratio of parasternal intercostal muscle-thickening fraction-to-diaphragm thickening fraction for predicting weaning failure. J Crit Care. 2024;83:154847. Available in: www.sciencedirect.com/science/article/pii/S0883944124003341https://doi.org/10.1016/j.jcrc.2024.154847

  16. Dres M, Dubé BP, Goligher E, Vorona S, Demiri S, Morawiec E, Mayaux J, Brochard L, Similowski T, Demoule A. Usefulness of parasternal intercostal muscle ultrasound during weaning from mechanical ventilation. Anesthesiology. 2020;132(5):1114-1125. doi: 10.1097/ALN.0000000000003191.




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