Predictive Value Of Ultrasonic Diaphragm Thickening Fraction Combined With Integrative Weaning Index In Weaning Patients With Mechanical Ventilation

Objective: The purpose of this study was to investigate the predictive value of ultrasonic diaphragm thickening fraction(DTF)combined with integrative weaning index(IWI)in weaning patients with mechanical ventilation.Methods: A total of 79 patients with mechanical ventilation who received oral endotracheal intubation in the intensive care unit of Ma’anshan people’s Hospital from September 2020 to September 2021 were selected.Their mechanical ventilation time was more than 24 hours and reached the start standard of spontaneous breathing test(SBT).Before the start of SBT test,the observation indexes including blood gas,arterial oxygen saturation(Sa O2),read platform pressure(Pplat),tidal volume(VT),positive end expiratory pressure(PEEP)and respiratory rate(f)in volume control mode were recorded,the integrative weaning index was calculated;After the start of SBT test,the end expiratory thickness and end inspiratory thickness of the patient’s right diaphragm were measured and recorded with solo bedside ultrasound in real time by one clinician with ultrasonic operation qualification,so as to calculate the diaphragm thickening score.SPSS 26.0 statistical software was used to draw receiver operating curve(ROC)to evaluate the predictive value of DTF and IWI for successful withdrawal,and the sensitivity and specificity were calculated according to the best critical value.Results:(1)The sensitivity of diaphragm thickening fraction(DTF)to predict successful weaning was 0.772,the specificity was 0.727,the best cutoff value was 0.293,respectively;and the area under the curve(AUC)was 0.72(95% CI 0.59 ～ 0.86),P = 0.003.(2)The sensitivity of integrative weaning index(IWI)to predict weaning success was 0.614,the specificity was 0.909,the best cut-off value was 53.00,and the area under the curve(AUC)was 0.82(95% CI 0.72 ～ 0.91),P < 0.001.(3)The combination of DTF and IWI was better than the single index in predicting the success of weaning,with which,the sensitivity was0.614,the specificity was 0.909,the best cut-off value was 17.848,and the area under the curve(AUC)was 0.84(95% CI 0.75 ～ 0.93),P < 0.001.Conclusion: DTF and IWI can provide guidance for the selection of weaning,while DTF combined with IWI can improve the effect of weaning prediction and provide support for patients’ weaning safety.