Evaluation of abdominal expiratory muscle thickness pattern, diaphragmatic excursion, diaphragmatic thickness fraction and lung ultrasound score in critically ill patients and their association with weaning patterns: A prospective study
Introduction: Weaning of patient from ventilator and finally extubation is a challenge, especially in critical care setup. Though many parameters are available, based on which, the decision of extubation is taken but still many times, there is failure of weaning. Aim: We conducted a prospective obse...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-04-01
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| Series: | Journal of Anaesthesiology Clinical Pharmacology |
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| Online Access: | https://journals.lww.com/10.4103/joacp.joacp_161_24 |
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| author | Priyanka Bansal Bhawna Jakhar Rajesh C. Arya Nidhi S. S. Sultania Sudha Puhal Kunal Bansal Devyani Verma Aditya Aggarwal Suresh Singhal |
| author_facet | Priyanka Bansal Bhawna Jakhar Rajesh C. Arya Nidhi S. S. Sultania Sudha Puhal Kunal Bansal Devyani Verma Aditya Aggarwal Suresh Singhal |
| author_sort | Priyanka Bansal |
| collection | DOAJ |
| description | Introduction:
Weaning of patient from ventilator and finally extubation is a challenge, especially in critical care setup. Though many parameters are available, based on which, the decision of extubation is taken but still many times, there is failure of weaning.
Aim:
We conducted a prospective observational study to look for diaphragm and abdominal muscle thickness, contraction, and lung ultrasound as indicator for weaning and extubation.
Material and Methods:
Patients of either gender aged between 20-50 years, who were on invasive mechanical ventilation for more than 48 hrs. and put on spontaneous breathing trial. A bedside ultrasound examination was performed. Abdominal expiratory muscle thickness, diaphragmatic excursion (DE), diaphragmatic thickness fraction (DTF) and lung ultrasound score (LUS) were measured.
Results:
12 patients had simple weaning pattern whereas 5 patients had difficult weaning and 8 patients had prolonged weaning. The mean value of DE was 1.97 cm, DTF- 2.3 mm. The mean value of SOFA score is significant between simple, difficult, prolonged weaning (2.24, 4.56, 7.33 respectively). The DE, which is 2.52, 1.26, 1.81 in simple difficult and prolonged weaning respectively is highly significant. The mean value of LUS was 8.34 and is significant in all weaning patterns. The highest sensitivity is found for SOFA score (84.62) with AUC of 0.88.
Conclusion:
Evaluation of patient with diaphragm thickness fraction (mean DTF of 26%) and diaphragm excursion (2.52 cm) with mean LUS score of 4.67 opens a new dimension to predict weaning in critically ill patients who are put on spontaneous breathing trial. The sequence of thickness of abdominal expiratory muscles adds to accuracy in successful weaning. Larger muti-center trials are required to make these parameters as a standard practice for weaning patients in critical care setup. |
| format | Article |
| id | doaj-art-735fb87f1a434d0d894f7c562c04be87 |
| institution | OA Journals |
| issn | 0970-9185 2231-2730 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Anaesthesiology Clinical Pharmacology |
| spelling | doaj-art-735fb87f1a434d0d894f7c562c04be872025-08-20T02:15:54ZengWolters Kluwer Medknow PublicationsJournal of Anaesthesiology Clinical Pharmacology0970-91852231-27302025-04-0141225726410.4103/joacp.joacp_161_24Evaluation of abdominal expiratory muscle thickness pattern, diaphragmatic excursion, diaphragmatic thickness fraction and lung ultrasound score in critically ill patients and their association with weaning patterns: A prospective studyPriyanka BansalBhawna JakharRajesh C. AryaNidhi S. S. SultaniaSudha PuhalKunal BansalDevyani VermaAditya AggarwalSuresh SinghalIntroduction: Weaning of patient from ventilator and finally extubation is a challenge, especially in critical care setup. Though many parameters are available, based on which, the decision of extubation is taken but still many times, there is failure of weaning. Aim: We conducted a prospective observational study to look for diaphragm and abdominal muscle thickness, contraction, and lung ultrasound as indicator for weaning and extubation. Material and Methods: Patients of either gender aged between 20-50 years, who were on invasive mechanical ventilation for more than 48 hrs. and put on spontaneous breathing trial. A bedside ultrasound examination was performed. Abdominal expiratory muscle thickness, diaphragmatic excursion (DE), diaphragmatic thickness fraction (DTF) and lung ultrasound score (LUS) were measured. Results: 12 patients had simple weaning pattern whereas 5 patients had difficult weaning and 8 patients had prolonged weaning. The mean value of DE was 1.97 cm, DTF- 2.3 mm. The mean value of SOFA score is significant between simple, difficult, prolonged weaning (2.24, 4.56, 7.33 respectively). The DE, which is 2.52, 1.26, 1.81 in simple difficult and prolonged weaning respectively is highly significant. The mean value of LUS was 8.34 and is significant in all weaning patterns. The highest sensitivity is found for SOFA score (84.62) with AUC of 0.88. Conclusion: Evaluation of patient with diaphragm thickness fraction (mean DTF of 26%) and diaphragm excursion (2.52 cm) with mean LUS score of 4.67 opens a new dimension to predict weaning in critically ill patients who are put on spontaneous breathing trial. The sequence of thickness of abdominal expiratory muscles adds to accuracy in successful weaning. Larger muti-center trials are required to make these parameters as a standard practice for weaning patients in critical care setup.https://journals.lww.com/10.4103/joacp.joacp_161_24critical care weaningdiaphragmatic exertiondiaphragmatic thickness fractionexpiratory abdominal muscle thicknesslung ultrasound scoresofa scoreweaning failureweaning from ventilation |
| spellingShingle | Priyanka Bansal Bhawna Jakhar Rajesh C. Arya Nidhi S. S. Sultania Sudha Puhal Kunal Bansal Devyani Verma Aditya Aggarwal Suresh Singhal Evaluation of abdominal expiratory muscle thickness pattern, diaphragmatic excursion, diaphragmatic thickness fraction and lung ultrasound score in critically ill patients and their association with weaning patterns: A prospective study Journal of Anaesthesiology Clinical Pharmacology critical care weaning diaphragmatic exertion diaphragmatic thickness fraction expiratory abdominal muscle thickness lung ultrasound score sofa score weaning failure weaning from ventilation |
| title | Evaluation of abdominal expiratory muscle thickness pattern, diaphragmatic excursion, diaphragmatic thickness fraction and lung ultrasound score in critically ill patients and their association with weaning patterns: A prospective study |
| title_full | Evaluation of abdominal expiratory muscle thickness pattern, diaphragmatic excursion, diaphragmatic thickness fraction and lung ultrasound score in critically ill patients and their association with weaning patterns: A prospective study |
| title_fullStr | Evaluation of abdominal expiratory muscle thickness pattern, diaphragmatic excursion, diaphragmatic thickness fraction and lung ultrasound score in critically ill patients and their association with weaning patterns: A prospective study |
| title_full_unstemmed | Evaluation of abdominal expiratory muscle thickness pattern, diaphragmatic excursion, diaphragmatic thickness fraction and lung ultrasound score in critically ill patients and their association with weaning patterns: A prospective study |
| title_short | Evaluation of abdominal expiratory muscle thickness pattern, diaphragmatic excursion, diaphragmatic thickness fraction and lung ultrasound score in critically ill patients and their association with weaning patterns: A prospective study |
| title_sort | evaluation of abdominal expiratory muscle thickness pattern diaphragmatic excursion diaphragmatic thickness fraction and lung ultrasound score in critically ill patients and their association with weaning patterns a prospective study |
| topic | critical care weaning diaphragmatic exertion diaphragmatic thickness fraction expiratory abdominal muscle thickness lung ultrasound score sofa score weaning failure weaning from ventilation |
| url | https://journals.lww.com/10.4103/joacp.joacp_161_24 |
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