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Open Access 01-12-2022 | Ultrasound | Research

Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study

Authors: Luigi Vetrugno, Daniele Orso, Francesco Corradi, Gianluca Zani, Savino Spadaro, Francesco Meroi, Natascia D’Andrea, Tiziana Bove, Gianmaria Cammarota, Edoardo De Robertis, Samuele Ferrari, Marcello Guarnieri, Margherita Ajuti, Maurizio Fusari, Domenico Luca Grieco, Cristian Deana, Enrico Boero, Federico Franchi, Sabino Scolletta, Salvatore Maurizio Maggiore, Francesco Forfori

Published in: Respiratory Research | Issue 1/2022

Abstract

Background

Diaphragmatic dysfunction is a major factor responsible for weaning failure in patients that underwent prolonged invasive mechanical ventilation for acute severe respiratory failure from COVID-19. This study hypothesizes that ultrasound measured diaphragmatic thickening fraction (DTF) could provide corroborating information for weaning COVID-19 patients from mechanical ventilation.

Methods

This was an observational, pragmatic, cross-section, multicenter study in 6 Italian intensive care units. DTF was assessed in COVID-19 patients undergoing weaning from mechanical ventilation from 1st March 2020 to 30th June 2021. Primary aim was to evaluate whether DTF is a predictive factor for weaning failure.

Results

Fifty-seven patients were enrolled, 25 patients failed spontaneous breathing trial (44%). Median length of invasive ventilation was 14 days (IQR 7–22). Median DTF within 24 h since the start of weaning was 28% (IQR 22–39%), RASS score (− 2 vs − 2; p = 0.031); Kelly-Matthay score (2 vs 1; p = 0.002); inspiratory oxygen fraction (0.45 vs 0.40; p = 0.033). PaO₂/FiO₂ ratio was lower (176 vs 241; p = 0.032) and length of intensive care stay was longer (27 vs 16.5 days; p = 0.025) in patients who failed weaning. The generalized linear regression model did not select any variables that could predict weaning failure. DTF was correlated with pH (RR 1.56 × 10²⁷; p = 0.002); Kelly-Matthay score (RR 353; p < 0.001); RASS (RR 2.11; p = 0.003); PaO₂/FiO₂ ratio (RR 1.03; p = 0.05); SAPS2 (RR 0.71; p = 0.005); hospital and ICU length of stay (RR 1.22 and 0.79, respectively; p < 0.001 and p = 0.004).

Conclusions

DTF in COVID-19 patients was not predictive of weaning failure from mechanical ventilation, and larger studies are needed to evaluate it in clinical practice further.

Registered: ClinicalTrial.gov (NCT05019313, 24 August 2021).

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Title: Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study
Authors: Luigi Vetrugno
Daniele Orso
Francesco Corradi
Gianluca Zani
Savino Spadaro
Francesco Meroi
Natascia D’Andrea
Tiziana Bove
Gianmaria Cammarota
Edoardo De Robertis
Samuele Ferrari
Marcello Guarnieri
Margherita Ajuti
Maurizio Fusari
Domenico Luca Grieco
Cristian Deana
Enrico Boero
Federico Franchi
Sabino Scolletta
Salvatore Maurizio Maggiore
Francesco Forfori
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Ultrasound
COVID-19
Ultrasound
Non-Invasive Ventilation
Published in: Respiratory Research / Issue 1/2022
Electronic ISSN: 1465-993X
DOI: https://doi.org/10.1186/s12931-022-02138-y

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