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2026, Number 4

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Med Crit 2026; 40 (4)

Utility of diaphragmatic excursion and thickening vs Tobin index as a predictor of extubation success in high-risk critically ill patients in the Intensive Care Unit

Jaime ZAY, Castañeda VCE, Velarde PAA

Language: Spanish
References: 27
Page: 269-273
PDF size: 903.16 Kb.


ABSTRACT

Introduction: mechanical ventilation is frequently required in intensive care units (ICU), with a reported use in 40-95% of critically ill patients. Once the underlying condition improves, assessing readiness for weaning and determining the optimal timing for extubation is crucial. The Tobin index is considered the gold standard due to its practicality, but it predicts only about 20% of weaning failures. Diaphragmatic ultrasound, by measuring excursion and medicinacriticathickening, has been proposed as a more accurate tool to improve prediction accuracy. Objective: to evaluate the usefulness of diaphragmatic excursion and thickening versus the Tobin index as predictors of extubation success in high-risk critically ill patients in the Intensive care unit. Material and methods: a cross-sectional, prospective, observational study aimed to determine the usefulness of diaphragmatic thickness and excursion by measuring them at the bedside and comparing them with the Tobin index to predict extubation success in high-risk critically ill patients. A sample of 80 patients was calculated, which included 10% of estimated losses. Qualitative variables were summarized as frequencies and proportions; quantitative variables as mean ± SD or median (IQR). Sensitivity, specificity, PPV, and NPV were calculated for diaphragmatic ultrasound parameters and the Tobin index. Statistical significance was assessed with chi-square tests. Results: of the total number of patients, 38.8% were female and 61.3% male; median age was 38 years (24.8-52). The most frequent admission diagnosis was traumatic brain injury (27.8%), followed by septic shock. Succesful extubation was achieved in 68.8%, while the main failure cause was respiratory failure (13.8%). Diaphragmatic excursion and thickening showed a sensitivity of 100% and a specificity of 80% (PPV 75%, NPV 100%), with an adequacy of 67.5% of both tests compared to a sensitivity of 100%, specificity of 31%, PPV of 75% and a NPV of 100% of the Tobin index. Successful weaning was observed in all patients with normal ultrasound findings, and failure to wean from IMV occurred in all patients with abnormal findings (p = 0.000). Conclusion: diaphragmatic ultrasound has been shown to be an effective predictor of successful extubation in high-risk critically ill patients. Further studies are suggested to provide a more in-depth understanding of its applicability and clinical utility.


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