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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2024

Open Access 01-12-2024 | Lung Ultrasound | Research

Combined cardiac, lung, and diaphragm ultrasound for predicting weaning failure during spontaneous breathing trial

Authors: Jia Song, Qiancheng Luo, Xinle Lai, Weihang Hu, Yihua Yu, Minjia Wang, Kai Yang, Gongze Chen, Wenwei Chen, Qian Li, Caibao Hu, Shijin Gong

Published in: Annals of Intensive Care | Issue 1/2024

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Abstract

Background

Weaning from invasive mechanical ventilation (MV) is a complex and challenging process that involves multiple pathophysiological mechanisms. A combined ultrasound evaluation of the heart, lungs, and diaphragm during the weaning phase can help to identify risk factors and underlying mechanisms for weaning failure. This study aimed to investigate the accuracy of lung ultrasound (LUS), transthoracic echocardiography (TTE), and diaphragm ultrasound for predicting weaning failure in critically ill patients.

Methods

Patients undergoing invasive MV for > 48 h and who were readied for their first spontaneous breathing trial (SBT) were studied. Patients were scheduled for a 2-h SBT using low-level pressure support ventilation. LUS and TTE were performed prospectively before and 30 min after starting the SBT, and diaphragm ultrasound was only performed 30 min after starting the SBT. Weaning failure was defined as failure of SBT, re-intubation, or non-invasive ventilation within 48 h.

Results

Fifty-one patients were included, of whom 15 experienced weaning failure. During the SBT, the global, anterior, and antero-lateral LUS scores were higher in the failed group than in the successful group. Receiver operating characteristic curve analysis showed that the areas under the curves for diaphragm thickening fraction (DTF) and global and antero-lateral LUS scores during the SBT to predict weaning failure were 0.678, 0.719, and 0.721, respectively. There was no correlation between the LUS scores and the average E/e’ ratio during the SBT. Multivariate analysis identified antero-lateral LUS score > 7 and DTF < 31% during the SBT as independent predictors of weaning failure.

Conclusion

LUS and diaphragm ultrasound can help to predict weaning failure in patients undergoing an SBT with low-level pressure support. An antero-lateral LUS score > 7 and DTF < 31% during the SBT were associated with weaning failure.

Graphical Abstract

Appendix
Available only for authorised users
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Metadata
Title
Combined cardiac, lung, and diaphragm ultrasound for predicting weaning failure during spontaneous breathing trial
Authors
Jia Song
Qiancheng Luo
Xinle Lai
Weihang Hu
Yihua Yu
Minjia Wang
Kai Yang
Gongze Chen
Wenwei Chen
Qian Li
Caibao Hu
Shijin Gong
Publication date
01-12-2024
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2024
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-024-01294-2

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