The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

Abstract Introduction Multiple studies have shown that diaphragmatic ultrasound can better predict the outcome of weaning in adults. However, there are few studies focusing on children, leading to a lack of sufficient clinical evidence for the application of diaphragmatic ultrasound in children. The purpose of this study was to investigate the predictive value of diaphragm ultrasound for weaning outcomes in critically ill children. Methods The study included 50 cases whose mechanical ventilation (MV) time was > 48 h, and all eligibles were divided into either the weaning success group (n = 39) or the weaning failure group (n = 11). Diaphragm thickness, diaphragmatic excursion (DE), and diaphragmatic thickening fraction (DTF) were measured in the zone of apposition. The maximum inspiratory pressure (PImax) was also recorded. Results The ventilatory treatment time (P = 0.002) and length of PICU stay (P = 0.013) in the weaning failure group was longer than the success group. Cut-off values of diaphragmatic measures associated with successful weaning were ≥ 21% for DTF with a sensitivity of 0.82 and a specificity of 0.81, whereas it was ≥0.86 cm H2O/kg for PImax with a sensitivity of 0.51 and a specificity of 0.82. The linear correlation analysis showed that DTF had a significant positive correlation with PImax in children (P = 0.003). Conclusions Diaphragm ultrasound has potential value in predicting the weaning outcome of critically ill children. DTF and PImax presented better performance than other diaphragmatic parameters. However, DE has limited value in predicting weaning outcomes of children with MV. Trial registration Current Controlled Trials ChiCTR1800020196, (Dec 2018).

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The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

10.21203/rs.2.11999/v2 ◽

2019 ◽

Author(s):

Yang Xue ◽

Zhen Zhang ◽

Chu-Qiao Sheng ◽

Yu-Mei Li ◽

Fei-Yong Jia

Keyword(s):

Critically Ill ◽

Predictive Value ◽

Treatment Time ◽

Critically Ill Children ◽

Failure Group ◽

Weaning Failure ◽

Successful Weaning ◽

Success Group ◽

Linear Correlation Analysis ◽

Weaning Outcome

Abstract Background: Multiple studies have shown that diaphragmatic ultrasound can better predict the outcome of weaning in adults. However, there are few studies focusing on children, leading to a lack of sufficient clinical evidence for the application of diaphragmatic ultrasound in children. The purpose of this study is to investigate the predictive value of diaphragm ultrasound for weaning outcomes in critically ill children. Methods: The study included 50 cases whose mechanical ventilation (MV) time was >48 h, and all eligibles were divided into either the weaning success group (n = 39) or the weaning failure group (n = 11). Diaphragm thickness, diaphragmatic excursion (DE), and diaphragmatic thickening fraction (DTF) were measured in the zone of apposition. The maximum inspiratory pressure (PImax) was also recorded. Results: The ventilatory treatment time ( P = 0.002) and length of PICU stay ( P = 0.013) in the weaning failure group was longer than the success group. Cut-off values of diaphragmatic measures associated with successful weaning were ≥21% for DTF with a sensitivity of 0.82 and a specificity of 0.81, whereas it was ≥0.86 cmH 2 O/kg for PImax with a sensitivity of 0.51 and a specificity of 0.82. The linear correlation analysis showed that DTF had significant correlation with PImax in children ( P = 0.003). Conclusions: Diaphragm ultrasound has great value in predicting the weaning outcome of critically ill children. DTF and PImax presented better performance than other diaphragmatic parameters. However, DE has limited value in predicting weaning outcomes of children with MV.

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The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

10.21203/rs.2.11999/v4 ◽

2019 ◽

Author(s):

Yang Xue ◽

Zhen Zhang ◽

Chu-Qiao Sheng ◽

Yu-Mei Li ◽

Fei-Yong Jia

Keyword(s):

Critically Ill ◽

Predictive Value ◽

Treatment Time ◽

Critically Ill Children ◽

Failure Group ◽

Weaning Failure ◽

Successful Weaning ◽

Success Group ◽

Linear Correlation Analysis ◽

Weaning Outcome

Abstract Background: Multiple studies have shown that diaphragmatic ultrasound can better predict the outcome of weaning in adults. However, there are few studies focusing on children, leading to a lack of sufficient clinical evidence for the application of diaphragmatic ultrasound in children. The purpose of this study was to investigate the predictive value of diaphragm ultrasound for weaning outcomes in critically ill children. Methods: The study included 50 cases whose mechanical ventilation (MV) time was >48 h, and all eligibles were divided into either the weaning success group (n = 39) or the weaning failure group (n = 11). Diaphragm thickness, diaphragmatic excursion (DE), and diaphragmatic thickening fraction (DTF) were measured in the zone of apposition. The maximum inspiratory pressure (PImax) was also recorded. Results: The ventilatory treatment time ( P = 0.002) and length of PICU stay ( P = 0.013) in the weaning failure group was longer than the success group. Cut-off values of diaphragmatic measures associated with successful weaning were ≥21% for DTF with a sensitivity of 0.82 and a specificity of 0.81, whereas it was ≥0.86 cm H 2 O/kg for PImax with a sensitivity of 0.51 and a specificity of 0.82. The linear correlation analysis showed that DTF had a significant positive correlation with PImax in children ( P = 0.003). Conclusions: Diaphragm ultrasound has potential value in predicting the weaning outcome of critically ill children. DTF and PImax presented better performance than other diaphragmatic parameters. However, DE has limited value in predicting weaning outcomes of children with MV.

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The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

10.21203/rs.2.11999/v3 ◽

2019 ◽

Author(s):

Yang Xue ◽

Zhen Zhang ◽

Chu-Qiao Sheng ◽

Yu-Mei Li ◽

Fei-Yong Jia

Keyword(s):

Critically Ill ◽

Predictive Value ◽

Treatment Time ◽

Critically Ill Children ◽

Failure Group ◽

Weaning Failure ◽

Successful Weaning ◽

Success Group ◽

Linear Correlation Analysis ◽

Weaning Outcome

Abstract Background: Multiple studies have shown that diaphragmatic ultrasound can better predict the outcome of weaning in adults. However, there are few studies focusing on children, leading to a lack of sufficient clinical evidence for the application of diaphragmatic ultrasound in children. The purpose of this study was to investigate the predictive value of diaphragm ultrasound for weaning outcomes in critically ill children. Methods: The study included 50 cases whose mechanical ventilation (MV) time was >48 h, and all eligibles were divided into either the weaning success group (n = 39) or the weaning failure group (n = 11). Diaphragm thickness, diaphragmatic excursion (DE), and diaphragmatic thickening fraction (DTF) were measured in the zone of apposition. The maximum inspiratory pressure (PImax) was also recorded. Results: The ventilatory treatment time (P = 0.002) and length of PICU stay (P = 0.013) in the weaning failure group was longer than the success group. Cut-off values of diaphragmatic measures associated with successful weaning were ≥21% for DTF with a sensitivity of 0.82 and a specificity of 0.81, whereas it was ≥0.86 cm H2O/kg for PImax with a sensitivity of 0.51 and a specificity of 0.82. The linear correlation analysis showed that DTF had a significant positive correlation with PImax in children (P = 0.003). Conclusions: Diaphragm ultrasound has potential value in predicting the weaning outcome of critically ill children. DTF and PImax presented better performance than other diaphragmatic parameters. However, DE has limited value in predicting weaning outcomes of children with MV.

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The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

10.21203/rs.2.11999/v1 ◽

2019 ◽

Author(s):

Yang Xue ◽

Zhen Zhang ◽

Chu-Qiao Sheng ◽

Yu-Mei Li ◽

Fei-Yong Jia

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Predictive Value ◽

Treatment Time ◽

Critically Ill Children ◽

Failure Group ◽

Weaning Failure ◽

Successful Weaning ◽

Registration Number ◽

Success Group

Abstract Background: Multiple studies have shown that diaphragmatic ultrasound can better predict the outcome of weaning in adults. However, there are few studies focusing on children, leading to a lack of sufficient clinical evidence for the application of diaphragmatic ultrasound in children. The purpose of this study was to investigate the predictive value of diaphragm ultrasound for weaning outcomes in critically ill children. Methods: Study included 50 cases whose mechanical ventilation(MV) time > 48 h, and all eligibles were divided into either the weaning success group (n = 39) or the weaning failure group (n = 11). Diaphragm thickness and diaphragmatic excursion (DE) were measured in the zone of apposition. The maximum inspiratory pressure (PImax) was also recorded. Results: The ventilatory treatment time (P = 0.002) and length of PICU stay (P = 0.013) in the weaning failure group was longer than the success group. Cut-off values of diaphragmatic measures associated with successful weaning were ≥ 21% for DTF with a sensitivity of 0.82, and a specificity of 0.81, whereas it was ≥ 8.40 mm for DE with a sensitivity of 0.62, and a specificity of 0.91. The linear correlation analysis showed that DTF had no significant correlation with PImax in children (P = 0.31). Conclusions: Diaphragm ultrasound has great value in predicting the weaning outcome of critically ill children. DTF and DE presented better performance than other diaphragmatic parameters. However, PImax has limited value in terms of reflecting the inspiratory muscle function of children with MV. Trial Registration: The trial ‘Early rehabilitation intervention for critically ill children’ has been registered at http://www.chictr.org.cn/showproj.aspx?proj=23132. Registration number: ChiCTR1800020196. Key words: Paediatric; mechanical ventilation; diaphragm; ultrasound; weaning; PImax

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Ultrasound assessment of diaphragmatic dysfunction as a predictor of weaning outcome from mechanical ventilation: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-021189 ◽

2018 ◽

Vol 8 (9) ◽

pp. e021189 ◽

Cited By ~ 9

Author(s):

Zhicheng Qian ◽

Ming Yang ◽

Lin Li ◽

Yaolong Chen

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Cochrane Library ◽

Secondary Outcome ◽

Diaphragmatic Dysfunction ◽

Failure Group ◽

Weaning Failure ◽

Successful Weaning ◽

Ultrasound Assessment ◽

Weaning Outcome

ObjectiveThe aim of this systematic review was to assess the diaphragmatic dysfunction (DD) as a predictor of weaning outcome.BackgroundSuccessful weaning depends on several factors: muscle strength, cardiac, respiratory and metabolic. Acquired weakness in mechanical ventilation is a growing important cause of weaning failure. With the development of ultrasonography, DD can be evaluated with ultrasound in weakness patients to predict weaning outcomes.MethodsThe Cochrane Library, PubMed, Embase, Ovid Medline, WanFang Data and CNKI were systematically searched from the inception to September 2017. Ultrasound assessment of DD in adult mechanical ventilation patients was included. Two independent investigators assessed study quality in accordance with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The primary outcome was diaphragmatic thickness and excursion in the weaning success and failure group. The secondary outcome was the influence of DD on weaning outcome.ResultsEleven studies involving a total of 436 patients were included. There were eight studies comparing diaphragmatic excursion (DE), five comparing the diaphragmatic thickening fraction (DTF) and two comparing DD between groups with and without successful weaning. Overall, the DE or DTF had a pooled sensitivity of 0.85 (95% CI 0.77 to 0.91) and a pooled specificity of 0.74 (95% CI 0.66 to 0.80) for predicting weaning success. There was high heterogeneity among the included studies (I2=80%; p=0.0006). The rate of weaning failure was significantly increased in patients with DD (OR 8.82; 95% CI 3.51 to 22.13; p<0.00001).ConclusionsBoth DE and DTF showed good diagnostic performance to predict weaning outcomes in spite of limitations included high heterogeneity among the studies. DD was found to be a predictor of weaning failure in critically ill patients.

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Use of the product of driving pressure and respiratory rate for predicting failure of weaning from mechanical ventilator in medical patients

10.21203/rs.2.24506/v1 ◽

2020 ◽

Author(s):

Ju Gong ◽

Bibo Zhang ◽

Xiaowen Huang ◽

Bin Li ◽

Jian Huang

Keyword(s):

Mechanical Ventilation ◽

Respiratory Rate ◽

Spontaneous Breathing Trial ◽

Plateau Pressure ◽

Driving Pressure ◽

Medical Patients ◽

Failure Group ◽

Weaning Failure ◽

Weaning Outcome

Abstract Background : Respiratory workload increment in the process of mechanical ventilation withdrawal is critical for the determination of weaning outcome. Pressure, tidal volume (Vt) and respiratory rate (RR ) are considered as patient’s respiratory power, albeit being affected by excessive respiratory load. We aimed to evaluate the performance of driving pressure (DP)×RR to predict the outcome of weaning. Methods : Plateau pressure (Pplat) and positive end-expiratory pressure tot (PEEPtot) were measured during mechanical ventilation, viz., (1) brief deep sedation, (2) on volume support ventilation of MV with Vt 6 ml/kg and a PEEP of 0 cm H 2 O, (3) Pplat and PEEPtot were measured by holding breath for 2s after inhalation and exhalation, respectively. The DP was determined as Pplat minus PEEPtot. The highest RR was recorded within 3 min during spontaneous-breathing trial (SBT). Patients that were able to tolerate SBT for 1 h were directly extubated. These measurements correlated well with weaning outcome. Notably, patients in the “failure” group failed the SBT, died, while others required reintubation or noninvasive ventilation within 48 h of extubation. Results : Out of the 61 patients studied, 22 failed weaning. During the withdrawal of ventilation, DP×RR was 134.2±33.2 cmH 2 O ·breaths/min and 238.5±61.7 cmH 2 O·breaths/min ( P =0.00), DP was 7.9±1.6 cmH 2 O and 9.7±2.3 cmH 2 O ( P =0.00), in the “success” and “failure” groups, respectively. The DP×RR index greater than 170 cmH 2 O·breaths/min had a sensitivity of 95.5% and a specificity of 89.7%, while DP index greater than 8.1 cmH 2 O had 81.8% sensitivity and 64.1% specificity to predict weaning failure. Conclusions : Measurement of DP×RR during withdrawal of ventilation may help predict weaning outcome. Noticeably, high DP×RR increased the likelihood of weaning failure.

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A prospective observational study on critically ill children with diaphragmatic dysfunction: clinical outcomes and risk factors

10.21203/rs.3.rs-19423/v2 ◽

2020 ◽

Author(s):

Yang Xue ◽

Chun-Feng Yang ◽

Yu Ao ◽

Ji Qi ◽

Fei-Yong Jia

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Clinical Outcomes ◽

Critically Ill ◽

Treatment Time ◽

Negative Impact ◽

Extubation Failure ◽

Critically Ill Children ◽

Diaphragmatic Dysfunction ◽

Factors Associated

Abstract Background Diaphragmatic dysfunction (DD) has a great negative impact on clinical outcomes, and it is a well-recognized complication in adult patients with critical illness. However, DD is largely unexplored in the critically ill pediatric population. The aim of this study was to identify risk factors associated with DD, and to investigate the effects of DD on clinical outcomes among critically ill children. Methods Diaphragmatic function was assessed by diaphragm ultrasound. According to the result of diaphragmatic ultrasound, all enrolled subjects were categorized into the DD group (n=24) and the non-DD group (n=46). Collection of sample characteristics in both groups include age, sex, height, weight, primary diagnosis, complications, laboratory findings, medications, ventilatory time and clinical outcomes. Results The incidence of DD in this PICU was 34.3%. The level of CRP at discharge (P=0.003) in the DD group was higher than the non-DD group, and duration of elevated C-reactive protein (CRP) (P<0.001), sedative days (P=0.008) and ventilatory treatment time (P<0.001) in the DD group was significantly longer than the non-DD group. Ventilatory treatment time and duration of elevated CRP were independently risk factors associated with DD. Patients in the DD group had longer PICU length of stay, higher rate of weaning or extubation failure and higher mortality. Conclusion DD is associated with poorer clinical outcomes in critically ill childern, which include a longer PICU length of stay, higher rate of weaning or extubation failure and a higher mortality. The ventilatory treatment time and duration of elevated CRP are main risk factors of DD in critically ill children.

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Increase of Oxygen Consumption during a Progressive Decrease of Ventilatory Support Is Lower in Patients Failing the Trial in Comparison with Those Who Succeed

Anesthesiology ◽

10.1097/aln.0b013e3181e81050 ◽

2010 ◽

Vol 113 (2) ◽

pp. 378-385 ◽

Cited By ~ 18

Author(s):

Giacomo Bellani ◽

Giuseppe Foti ◽

Ester Spagnolli ◽

Manuela Milan ◽

Alberto Zanella ◽

...

Keyword(s):

Oxygen Consumption ◽

Pressure Support ◽

Ventilatory Support ◽

Respiratory Drive ◽

Failure Group ◽

Support Level ◽

Weaning Failure ◽

Ventilatory Assistance ◽

Success Group ◽

Metabolic Module

Background The aim of this study was to test the hypothesis that, during weaning from mechanical ventilation, when the pressure support level is reduced, oxygen consumption increases more in patients unable to sustain the decrease in ventilatory assistance (weaning failure). Methods Patients judged eligible for weaning were enrolled. Starting from 20 cm H2O, pressure support was decreased in 4-cm H2O steps, lasting 10 min each, until 0 cm H2O; this level was kept for 1 h. The average oxygen consumption from the last 3 min of each step, along with other ventilatory variables, was measured by indirect calorimetry (M-CAiOVX "metabolic module," Engstrom Carestation; GE Healthcare, Madison, WI) and recorded. Patients were defined as belonging to the failure group if, at any moment, they developed signs of respiratory distress according to standard criteria, or to the success group otherwise. Results Twenty-eight patients were studied. In most patients, the minimum oxygen consumption was not recorded at the highest pressure support applied. Sixteen patients were able to complete the weaning trial successfully, whereas 12 failed it; the success group had a minimum oxygen consumption lower than failure group (mean +/- SD: 174 +/- 44 vs. 215 +/- 53 ml/min, P < 0.05). Moreover, although respiratory drive (assessed by P0.1) increased more in the failure group, this group had a lower increase in oxygen consumption, contradicting our hypothesis. Conclusions Patients failing a decremental pressure support trial, in comparison with those who succeed, had an higher baseline oxygen consumption and were not able to increase their oxygen consumption in response to an increased demand.

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Serum NGAL in Critically Ill Children in ICU from a Single Center in Egypt

ISRN Nephrology ◽

10.5402/2013/140905 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Doaa Mohammed Youssef ◽

Asmaa Mohammed Esh ◽

Ebthag Helmy Hassan ◽

Tahia Mohammed Ahmed

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Critically Ill ◽

Predictive Value ◽

Characteristic Curve ◽

Kidney Injury ◽

Critically Ill Children ◽

Control Group ◽

Mortality And Morbidity ◽

Neutrophil Gelatinase Associated Lipocalin

Introduction. The mortality and morbidity associated with acute kidney injury (AKI), unfortunately, remain unacceptably high. We aimed to detect the extent of serum neutrophil gelatinase-associated lipocalin (NGAL) to early detect AKI in critically ill children. Subjects and Methods. This is a case control study. It included 75 subjects that include 15 as controls and 60 critically ill children. Patients were further subdivided according to RIFLE criteria into two other categories: patients who developed AKI and patients who did not develop AKI. Serum NGAL assayed on admission and after 3 days. Results. There was significant increase in the level of NGAL among patients group when compared with control group. Also, 21.7% of children admitted to PICU developed AKI from which 8.3% needed dialysis. The receiver operating characteristic curve of NGAL at day 0 revealed AUC of 0.63 with 95% CI of 0.50–0.77. At a cutoff value of 89.5 ng/mL, the sensitivity of NGAL was 84.6%, while specifcity was 59.6%, positive predictive value was 36.7%, negative predictive value was 68.4%, and accuracy was 93.3% in diagnosis of AKI. Conclusion. We found that NGAL acts as a sensitive marker rather than a specific one for AKI. At the same time, it presents as a negative predictive value more valuable than being a positive predictive value in detecting AKI.

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Evaluation of a Portable Infrared End-Tidal Carbon Dioxide Monitor During Pediatric Interhospital Transport

PEDIATRICS ◽

10.1542/peds.95.6.875 ◽

1995 ◽

Vol 95 (6) ◽

pp. 875-878

Author(s):

Mananda S. Bhende ◽

Valerie A. Karr ◽

Drew C. Wiltsie ◽

Richard A. Orr

Keyword(s):

Carbon Dioxide ◽

Critically Ill ◽

Predictive Value ◽

Tertiary Care ◽

False Negative ◽

Critically Ill Children ◽

Arterial Blood ◽

Interhospital Transport ◽

End Tidal Carbon Dioxide ◽

End Tidal

Purpose. Critically ill children often require endotracheal intubation before transport to a tertiary care center. Correct endotracheal tube (ETT) placement (trachea versus esophagus) and maintenance during transport are of the utmost importance. We evaluated a portable, qualitative, infrared end-tidal carbon dioxide monitor during transport of critically ill children. Methods. Fifty patients, ages 1 day to 19 years (median, 1 year), weighing 1.6 to 70 kg (median, 10 kg) who were intubated and transported by ground ambulance (n = 25) or rotorcraft (n = 25) were enrolled. ETT position was confirmed by physical examination, arterial blood gas or pulse oximetry, and sometimes by a chest radiograph. The instrument was attached, and readings were obtained before and during transport by transport nurses or respiratory therapists who also completed a brief questionnaire about the monitor. A moving bar indicator with a light-emitting diode display on the instrument indicates the presence of expired carbon dioxide. Results. All three esophageal tube positions and 48 of 50 tracheal tube positions were correctly identified (sensitivity, 96%; specificity, 100%; positive predictive value, 100%; and negative predictive value, 60%). There were two false-negative results: in one case, there was instrument malfunction because of blood backing up into the tubing because of traumatic intubation, and in the second case, the patient had a chest tube that was leaking air. The device was evaluated as "too large" (30 of 50), "hard to secure" (25 of 50), and "not convenient" (29 of 50). Tube kinking was a problem (n = 7) when used in small infants in isolettes. The instrument was considered helpful in assuring ETT position when clinical evaluation was not possible because of noisy conditions. Conclusions. We conclude that this carbon dioxide monitor was useful during transport of critically ill children in confirming ETT position. Further improvements in this noninvasive technology might be helpful in making the device more practical for use during interhospital transport.

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