Comparison of assessment of diaphragm function using speckle tracking between patients with successful and failed weaning: a multicentre, observational, pilot study

BMC Pulmonary Medicine

Research

Weihua Lu¹  Xiao Yang²  Bo Hu²  Shuhan Cai²  Jianguo Li²  Chang Hu²  Qiancheng Xu³  Yan Qian⁴ 

[1] Department of Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), 241000, Wuhu, Anhui, China;Anhui Provincial Clinical Research Center for Critical Respiratory Disease, 241000, Wuhu, Anhui, China;Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, 430071, Wuhan, Hubei, China;Clinical Research Center of Hubei Critical Care Medicine, 430071, Wuhan, Hubei, China;Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, 430071, Wuhan, Hubei, China;Clinical Research Center of Hubei Critical Care Medicine, 430071, Wuhan, Hubei, China;Department of Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), 241000, Wuhu, Anhui, China;Anhui Provincial Clinical Research Center for Critical Respiratory Disease, 241000, Wuhu, Anhui, China;Department of Emergency Intensive Care Unit, EastChina Normal University, Wuhu Hospital, 241000, Wuhu, Anhui, China;

关键词: Speckle tracking;    Diaphragm;    Ultrasound;    Strain;    Weaning;    Mechanical ventilation;   

DOI  :  10.1186/s12890-022-02260-z

 received in 2022-08-07, accepted in 2022-11-24,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundDiaphragmatic ultrasound has been increasingly used to evaluate diaphragm function. However, current diaphragmatic ultrasound parameters provide indirect estimates of diaphragmatic contractile function, and the predictive value is controversial. Two-dimensional (2D) speckle tracking is an effective technology for measuring tissue deformation and can be used to measure diaphragm longitudinal strain (DLS) to assess diaphragm function. The purpose of this study was to determine the feasibility and reproducibility of DLS quantification by 2D speckle tracking and to determine whether maximal DLS could be used to predict weaning outcomes.MethodsThis study was performed in the intensive care unit of two teaching hospitals, and was divided into two studies. Study A was a prospective study to evaluate the feasibility, reliability, and repeatability of speckle tracking in assessing DLS in healthy subjects and mechanically ventilated patients. Study B was a multicentre retrospective study to assess the use of maximal DLS measured by speckle tracking in predicting weaning outcomes.ResultsTwenty-five healthy subjects and twenty mechanically ventilated patients were enrolled in Study A. Diaphragmatic speckle tracking was easily accessible. The intra- and interoperator reliability were good to excellent under conditions of eupnoea, deep breathing, and mechanical ventilation. The intraclass correlation coefficient (ICC) ranged from 0.78 to 0.95. Ninety-six patients (fifty-nine patients were successfully weaned) were included in Study B. DLS exhibited a fair linear relationship with both the diaphragmatic thickening fraction (DTF) (R2 = 0.73, p < 0.0001) and diaphragmatic excursion (DE) (R2 = 0.61, p < 0.0001). For the prediction of successful weaning, the areas under the ROC curves of DLS, diaphragmatic thickening fraction DTF, RSBI, and DE were 0.794, 0.794, 0.723, and 0.728, respectively. The best cut-off value for predicting the weaning success of DLS was less than -21%, which had the highest sensitivity of 89.19% and specificity of 64.41%.ConclusionsDiaphragmatic strain quantification using speckle tracking is easy to obtain in healthy subjects and mechanically ventilated patients and has a high predictive value for mechanical weaning. However, this method offers no advantage over RSBI. Future research should assess its value as a predictor of weaning.Trial registrationThis study was registered in the Chinese Clinical Trial Register (ChiCTR), ChiCTR2100049816. Registered 10 August 2021. http://www.chictr.org.cn/showproj.aspx?proj=131790

【 授权许可】

CC BY   
© The Author(s) 2022

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