A Study On The Ability Of Combination Of Lungultrasonic B-line Score And Diaphragmatic Displacement To Predict Weaning From Mechanical Ventilation

Objective:To verify whether the combination of lungultrasonic B-line score and diaphragmatic displacement can improve the successful weaning from mechanical ventilation.The value of combination of lung-ultrasonic B-line score and diaphragmatic displacement in predicting successful weaning from mechanical ventilation is also analyzed to guide the assessment of correct weaning time.Methods: The study included 92 adult patients(From August 2016 to August 2017)who need for invasive mechanical ventilation in surgical ICU and Medical ICU of Zhangzhou Affiliated Hospital of Fujian Medical University.We collected the baseline information of all patients.All patients underwent SBT using PSV method.We measured LUBS,DD,EF,LAP,BNP at 30 min after SBT.Patients were weaning ventilator after passing SBT.SBT,LUBS,DD,EF,LAP,BNP measurements were reaccessed 4 hours after weaning ventilator.Successful weaning(n=69)was defined as the patient not requiring reintubation or additional respiratory support,such as noninvasive positive-pressure ventilation within 48 hours of ventilator weaning.Weaning failure(n=23,include noninvasive ventilation=14,reintubation=9)was defined as reintubation or additional respiratory support within 48 hours after weaning ventilator.Results:(1)The patients were classified into a success group(69 patients)or a failure group(23 patients)according to the weaning outcome.There was no significant difference between two groups in age,ventilation time,APACHE-II,negative fluid balance before weaning;baseline disease characteristics.EF value of success group was significantly higher than that of failure group,while LAP and BNP(30min SBT) value of success group was significantly lower than that of failure group.(2)The change of BNP value from 30 min SBT to 4 hours SBT was greater in failure group than that in success group(P<0.05).(3)The sensitivity and specificity of predicting successful weaning by combining lung ultrasonic B-line score and diaphragmatic displacement was higher than that by lung ultrasonic B-line score(AUC 0.985 vs 0.862,P<0.05).The sensitivity and specificity of predicting successful weaning by combining lung ultrasonic B-line score and diaphragmatic displacement was also higher than that by diaphragmatic displacement(AUC 0.985 vs 0.910,P<0.05).No significant difference was observed in sensitivity of predicting successful weaning by lung ultrasonic B-line score or diaphragmatic displacement(AUC 0.862 vs 0.910,P>0.05).A receiver operating characteristic curve indicated that combining lung-ultrasonic B-line score and diaphragmatic displacement is more beneficial to predict successful weaning from mechanical ventilation than lung-ultrasonic B-line score or diaphragmatic displacement.Conclusion:Combining lung-ultrasonic B-line score with diaphragmatic displacement is more susceptibility and specificity to predict successful weaning from mechanical ventilation than single assessment.