Background: This study investigated dyspnoea intensity and respiratory muscle ultrasound early after extubation to predict extubation failure.
Methods: The study was conducted prospectively in two intensive care units in France and Canada. Patients intubated for at least 48 h were studied within 2 h after an extubation following a successful spontaneous breathing trial. Dyspnoea was evaluated by a dyspnoea visual analogue scale (Dyspnoea-VAS) ranging from 0 to 10 and the Intensive Care Respiratory Distress Observational Scale (IC-RDOS). The ultrasound thickening fraction of the parasternal intercostal and the diaphragm was measured; limb muscle strength was evaluated using the Medical Research Council (MRC) score (range 0-60).
Results: Extubation failure occurred in 21 out of 122 enrolled patients (17%). The median (interquartile range (IQR)) Dyspnoea-VAS and IC-RDOS were higher in patients with extubation failure success: 7 (4-9) 3 (1-5) (p<0.001) and 3.7 (1.8-5.8) 1.7 (1.5-2.1) (p<0.001), respectively. The median (IQR) ratio of parasternal intercostal muscle to diaphragm thickening fraction was significantly higher and MRC was lower in patients with extubation failure compared with extubation success: 0.9 (0.4-2.1) 0.3 (0.2-0.5) (p<0.001) and 45 (36-50) 52 (44-60) (p=0.012), respectively. The thickening fraction of the parasternal intercostal and its ratio to diaphragm thickening showed the highest area under the receiver operating characteristic curve (AUC) for an early prediction of extubation failure (0.81). AUCs of Dyspnoea-VAS and IC-RDOS reached 0.78 and 0.74, respectively.
Conclusions: Respiratory muscle ultrasound and dyspnoea measured within 2 h after extubation predict subsequent extubation failure.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1183/13993003.00002-2021 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Early weaning from invasive mechanical ventilation via high-flow nasal oxygen versus conventional weaning in patients with hypoxemic respiratory failure: a prospective randomized controlled study.
Crit Care Sci
January 2025
Anaesthesiology and Critical Care, All India Institute of Medical Sciences - Jodhpur, India.
Objective: Although the efficacy of high-flow nasal oxygen therapy in delaying or avoiding intubation in patients with hypoxemic respiratory failure has been studied, its potential for facilitating early weaning from invasive mechanical ventilation remains unexplored.
Methods: In this randomized controlled trial, 80 adults with acute hypoxemic respiratory failure requiring invasive mechanical ventilation for > 48 hours were enrolled and divided into two groups: conventional weaning and early weaning via high-flow nasal oxygen. In the conventional weaning group, the spontaneous breathing trial was performed after the PaO2/FiO2 ratio was ≥ 200, whereas in the high-flow nasal oxygen group, the spontaneous breathing trial was conducted earlier when the PaO2/FiO2 ratio was 150 - 200.
Optimizing Sedation Strategies in the Cardiac ICU: Induction, Maintenance and Weaning.
Curr Cardiol Rep
January 2025
Cardiovascular Division, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA.
Purpose Of Review: We aim to summarize the available literature guiding tailored sedation practices for specific conditions encountered in the Cardiovascular Intensive Care Unit (CICU).
Recent Findings: Data specific for the CICU population is lacking. Preclinical data and observational studies guide sedation approaches for specific pathologies that we have used to generate a guideline for sedative choice for various scenarios.
Sensitivity and Specificity of the Yale Swallow Protocol in Recently Extubated Patients.
Am J Speech Lang Pathol
January 2025
Purpose: The purpose of this study was to determine the sensitivity and specificity of the Yale Swallow Protocol (YSP) in detecting aspiration in recently extubated patients.
Method: One hundred fifty-four participants referred for swallowing evaluation underwent the YSP and fiberoptic endoscopic evaluation of swallowing (FEES) in random order within 48 hr of extubation. The YSP included orientation questions, an oral motor exam, and a 3-oz water swallow test.
The Efficacy of the Charlson Comorbidity Index and Its Age-Adjusted Version in Forecasting Mortality and Postoperative Outcomes Following Isolated Coronary Artery Bypass Grafting.
J Clin Med
January 2025
Department of Cardiovascular Surgery, School of Medicine, Kocaeli University, 41001 Kocaeli, Turkey.
: The Charlson Comorbidity Index (CCI) is designed for evaluating comorbidities and mortality risks, with the age-adjusted CCI (ACCI) combining age and comorbidity assessments. Despite its long-standing use, research on CCI's application in cardiac surgery patients is limited. This study assessed the effectiveness of CCI and ACCI in predicting in-hospital mortality and post-surgery outcomes for patients undergoing isolated coronary artery bypass grafting (CABG).
View Article and Find Full Text PDFRole of heart rate variability in predicting tracheal extubation failure: a systematic review and meta-analysis.
Br J Anaesth
January 2025
Department of Anesthesia and Pain, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada. Electronic address:
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!