The Study Of The Guiding Value Of The Diaphragm Movement Tested By Ultrosonography To The Weaning

Objective We assessed the diaphragm movement of weaning patients by ultrosonography,and analyze the value of diaphragm index,measured by ultrosonography,in predicting weaning from mechanical ventilation.Methods Forty patients with mechanical ventilation for at least 48h from September 2017 to February 2018 were enrolled in EICU at Hunan Provincial People's Hospital.patients received spontaneous breathing trial(SBT)under low levels of pressure support ventilation during the period of 1 hour SBT,the index of diaphragm movement was measured with bedside ultrosonography,including diaphragm displacement?diaphragmatic-rapid shallow breathing index?The rapid shallow breathing index(RSBI).The weaning patients who met the weaning criteria were divided into two groups:weaning successful group and weaning failure group,according to the weaning outcome.The receiver operating characteristic curve(ROC)was used to evaluate the predictive value of each index to the failure of the weaning.Results 1.A total of forty patients were enrolled in this study,including 28 successfully weaning and 12 failed,No statistically significant differences in pre-weaning parameters,including gender,age,BMI,smoking status,APACHE ? score(Acute Physiology and Chronic Health Evaluation? score),the reasons for mechanical ventilation,complications,surgery and drug use,were detected between weaning success and weaning failure groups,(P>0.05).2.No statistically significant differences in pre-SBT parameters,including pH,PaC02,oxygenation index,heart rate and systolic pressure,were detected between weaning success and weaning failure groups,(P>0.05).3.The mechanical ventilation time(12.5d)and hospital stay(22.6d)in the failure group were longer than those in the successful weaning group(7.0d,15.3d),the difference was statistically significant(P<0.05).no statistically significant differences in the death toll were detected between the two groups(P>0.05).4.No statistically significant differences in RR(Respiratory rate)and VT(Tidal volume)were detected between the two groups(P>0.05).the diaphragmatic displacement in the failure weaned group(9.56±2.13mm)was less than that in the successful group(13.66±4.10mm),the difference was statistically significant(P<0.05).Both diaphragmatic-rapid shallow breathing index[2.06±0.68(breaths/min·mm)]and RSBI[61.70±25.00(breaths/min·1)]were greater than the weaning success group[1.44±0.66(breaths/min ·mm);44.91±14.51(breaths/min·1)],the difference was statistically significant(P<0.05).5.The cutoff value of RSBI for predicting weaning failure was determined to be 53.46(breaths/min·1)by ROC curve analysis,The sensitivity of RSBI to predict weaning failure was 58.3%and the specificity was 75.0%,the AUCROC was 0.711;The cutoff value of diaphragmatic displacement for predicting weaning failure was determined to be 11.15 mm by ROC curve analysis,The sensitivity of diaphragmatic displacement to predict weaning failure was 83.3%and the specificity was 71.4%,the AUCRocwas 0.830,which is superior to RSBI in predicting weaning failure;The cutoff value of diaphragmatic-rapid shallow breathing index for predicting weaning failure was determined to be 1.42(breaths/min·mm)by ROC curve analysis,The sensitivity of diaphragmatic displacement to predict weaning failure was 91.7%and the specificity was 82.1%,the AUCRoc was 0.851,which is superior to RSBI in predicting weaning failure.Conclusions 1.Through ultrasound examination,the patients who failed weaning had a decline displacement of diaphragm motion,that is,the dysfunction of the diaphragm.2.The index of diaphragm motion measured by ultrosonography,including diaphragm displacement,diaphragmatic-rapid shallow breathing index,can predict the failure of the weaning accurately.3.The index of diaphragm motion measured by ultrosonography,is superior to the RSBI in guiding weaning,which has a guiding role in the prediction of the outcome of weaning.