TY - JOUR T1 - Pulmonary Ultrasound and Diaphragmatic Shortening Fraction Combined Analysis for Extubation-Failure-Prediction in Critical Care Patients JO - Archivos de Bronconeumología T2 - AU - González-Aguirre,Julio E. AU - Rivera-Uribe,Claudia Paola AU - Rendón-Ramírez,Erick Joel AU - Cañamar-Lomas,Rogelio AU - Serna-Rodríguez,Juan Antonio AU - Mercado-Longoría,Roberto SN - 03002896 M3 - 10.1016/j.arbres.2018.09.015 DO - 10.1016/j.arbres.2018.09.015 UR - https://archbronconeumol.org/en-pulmonary-ultrasound-diaphragmatic-shortening-fraction-articulo-S0300289618303491 AB - IntroductionInvasive respiratory support is a cornerstone of Critical Care Medicine, however, protocols for withdrawal of mechanical ventilation are still far from perfect. Failure to extubation occurs in up to 20% of patients, despite a successful spontaneous breathing trial (SBT). MethodsWe prospectively included ventilated patients admitted to medical and surgical intensive care unit in a university hospital in northern Mexico. At the end of a successful SBT, we measured diaphragmatic shortening fraction (DSF) by the formula: diaphragmatic thickness at the end of inspiration – diaphragmatic thickness at the end of expiration/diaphragmatic thickness at the end of expiration×100, and the presence of B-lines in five regions of the right and left lung. The primary objective was to determine whether analysis of DSF combined with pulmonary ultrasound improves prediction of extubation failure. ResultsEighty-two patients were included, 24 (29.2%) failed to extubation. At univariate analysis, DSF (Youden's J: >30% [sensibility and specificity 62 and 50%, respectively]) and number of B-lines regions (Youden's J: >1 zone [sensibility and specificity 66 and 92%, respectively]) were significant related to extubation failure (area under the curve 0.66 [0.52–0.80] and 0.81 [0.70–0.93], respectively). At the binomial logistic regression, only the number of B-lines regions remains significantly related to extubation failure (OR 5.91 [2.33–14.98], P<.001). ConclusionIn patients with a successfully SBT, the absence of B-lines significantly decreases the probability of extubation failure. Diaphragmatic shortening fraction analysis does not add predictive power over the use of pulmonary ultrasound. ER -