Hernández PAE, Gómez GMN, Soriano OR, Díaz RJA, González CPL

Language: Spanish
References: 10
Page: 253-257
PDF size: 153.17 Kb.

ABSTRACT

Introduction: Mechanical ventilation has been fundamental in the management of critical patients. Almost 25% of patients ventilated will present difficulties in weaning process, which may be due to multiple causes. Delay or prolongation is associated with various complications. There are currently important factors for the failure of ventilatory weaning, such as diaphragmatic dysfunction, which has been consistently characterized following the advent of critical ultrasonography, it is associated with increase in days of ventilation and impact on mortality, despite of this facti, is underdiagnosed. Predictors of success or failure in weaning process has been established by means of diaphragmatic ultrasound; however, they are found as isolated parameters, so it is necessary to develop ultrasonic predictive models, in addition to the clinical ones, for a safe ventilatory weaning.
Methods: A total of 90 patients with admission to the intensive care unit with mechanical ventilation and weaning protocol were analyzed in a first stage. Clinical, ventilatory and ultrasonographic measurements were performed, being the most statistically significant, ultrasonographic, and therefore an ultrasonographic predictive model was designed consisting of 4 items with a maximum score of 8 points and a minimum of 0. It was established a point of greater sensitivity and specificity for the test.
Results: After the application and statistical analysis of the ultrasonographic predictive model, sensitivity of 0.91 and specificity of 0.69 were obtained, with positive and negative predictive value of 89% and 75%, respectively, with ROC area of ​​0.80.
Conclusions: The ultrasonographic predictive model, designed to identify patients with possible success, is also a predictor of the failure of mechanical ventilation.

REFERENCES

1. Osman AM. Diaphragmatic and lung ultrasound application as new predictive indices for the weaning process in ICU patients. The Egyptian Journal of Radiology and Nuclear Medicine. 2017;48:61-66.

2. Ramzy AE. Diaphragm ultrasound as a new functional and morphological index of outcome, prognosis and discontinuation from mechanical ventilation in critically ill patients and evaluating the possible protective indices against VIDD. Egyptian Journal of Chest Diseases and Tuberculosis. 2017;66:339-351.

3. Peñuelas O, Frutos-Vivar F, Fernández C, Anzueto A, Epstein SK, Apezteguía C, et al. Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation. Am J Respir Crit Care Med. 2011;184(4):430-437.

4. Kim WY, Suh HJ, Hong SB, Koh Y, Lim CM. Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation. Crit Care Med. 2011;39(12):2627-2630.

5. Jubran A. Critical illness and mechanical ventilation: effects on the diaphragm. Respir Care. 2006;51:1054-1061.

6. Petrof BJ, Jaber S, Matecki S. Ventilator-induced diaphragmatic dysfunction. Curr Opin Crit Care. 2016;16:19-25.

7. Hermans G, van den Berghe G. Clinical review: intensive care unit acquired weakness. Crit Care. 2015;19:274.

8. Matamis D, Soilemezi E, Tsagourias M, Akoumianaki E, Dimassi S, Boroli F, et al. Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications. Intensive Care Med. 2013;39(5):801-810.

9. DiNino E. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax. 2014;69:423-427.

10. Heunks LM, Doorduin J, van der Hoeven JG. Monitoring and preventing diaphragm injury. Curr Opin Crit Care. 2015;21:34-41.