Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Oct 4;8(9):e021189.
doi: 10.1136/bmjopen-2017-021189.

Ultrasound assessment of diaphragmatic dysfunction as a predictor of weaning outcome from mechanical ventilation: a systematic review and meta-analysis

Zhicheng Qian  1 , Ming Yang  2 , Lin Li  3 , Yaolong Chen  4
Affiliations
Meta-Analysis

Ultrasound assessment of diaphragmatic dysfunction as a predictor of weaning outcome from mechanical ventilation: a systematic review and meta-analysis

Zhicheng Qian et al. BMJ Open. .

Abstract

Objective: The aim of this systematic review was to assess the diaphragmatic dysfunction (DD) as a predictor of weaning outcome.

Background: Successful weaning depends on several factors: muscle strength, cardiac, respiratory and metabolic. Acquired weakness in mechanical ventilation is a growing important cause of weaning failure. With the development of ultrasonography, DD can be evaluated with ultrasound in weakness patients to predict weaning outcomes.

Methods: The Cochrane Library, PubMed, Embase, Ovid Medline, WanFang Data and CNKI were systematically searched from the inception to September 2017. Ultrasound assessment of DD in adult mechanical ventilation patients was included. Two independent investigators assessed study quality in accordance with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The primary outcome was diaphragmatic thickness and excursion in the weaning success and failure group. The secondary outcome was the influence of DD on weaning outcome.

Results: Eleven studies involving a total of 436 patients were included. There were eight studies comparing diaphragmatic excursion (DE), five comparing the diaphragmatic thickening fraction (DTF) and two comparing DD between groups with and without successful weaning. Overall, the DE or DTF had a pooled sensitivity of 0.85 (95% CI 0.77 to 0.91) and a pooled specificity of 0.74 (95% CI 0.66 to 0.80) for predicting weaning success. There was high heterogeneity among the included studies (I2=80%; p=0.0006). The rate of weaning failure was significantly increased in patients with DD (OR 8.82; 95% CI 3.51 to 22.13; p<0.00001).

Conclusions: Both DE and DTF showed good diagnostic performance to predict weaning outcomes in spite of limitations included high heterogeneity among the studies. DD was found to be a predictor of weaning failure in critically ill patients.

Keywords: diaphragmatic dysfunction; diaphragmatic excursion; diaphragmatic thickness fraction; weaning mechanical ventilation.

PubMed Disclaimer

Conflict of interest statement

Competing interests: The authors declared no competing interests.

Figures

Figure 1
Figure 1
Selection of studies included in this meta-analysis.
Figure 2
Figure 2
Assessment of risk of bias of studies: QUADAS-2 tool. QUADAS-2, Quality Assessment of Diagnostic Accuracy Studies-2.
Figure 3
Figure 3
Funnel plot comparison of diaphragmatic excursion between different weaning outcomes by MD. MD, mean difference.
Figure 4
Figure 4
Diaphragmatic excursion (DE) or diaphragmatic thickening fraction (DTF) to predict weaning success.
Figure 5
Figure 5
Summary of the receiver operating characteristic curve plotting sensitivity against specificity.
Figure 6
Figure 6
Mean difference of diaphragmatic excursion between the weaning failure and weaning success groups. IV, inverse variance.
Figure 7
Figure 7
The diaphragmatic thickening fraction mean difference between the weaning failure and weaning success groups. IV, inverse variance.
Figure 8
Figure 8
Weaning failure between the diaphragmatic dysfunction and normal groups. M-H, Mantel-Haenszel.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Tanios MA, Nevins ML, Hendra KP, et al. . A randomized, controlled trial of the role of weaning predictors in clinical decision making. Crit Care Med 2006;34:2530–5. 10.1097/01.CCM.0000236546.98861.25 - DOI - PubMed
    1. Esteban A, Anzueto A, Frutos F, et al. . Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 2002;287:345–55. 10.1001/jama.287.3.345 - DOI - PubMed
    1. Torres A, Gatell JM, Aznar E, et al. . Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 1995;152:137–41. 10.1164/ajrccm.152.1.7599812 - DOI - PubMed
    1. Thille AW, Richard JC, Brochard L. The decision to extubate in the intensive care unit. Am J Respir Crit Care Med 2013;187:1294–302. 10.1164/rccm.201208-1523CI - DOI - PubMed
    1. Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure--a structured approach. Crit Care 2010;14:245 10.1186/cc9296 - DOI - PMC - PubMed

LinkOut - more resources