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. 2021 Nov 11;58(5):2100002.
doi: 10.1183/13993003.00002-2021. Print 2021 Nov.

Dyspnoea and respiratory muscle ultrasound to predict extubation failure

Martin Dres  1   2   3   4 , Thomas Similowski  5   2 , Ewan C Goligher  4   6 , Tai Pham  3   7   8 , Liliya Sergenyuk  5 , Irene Telias  3   4   6 , Domenico Luca Grieco  3   9   10 , Wissale Ouechani  5 , Detajin Junhasavasdikul  3   11 , Michael C Sklar  3   4 , L Felipe Damiani  3   12 , Luana Melo  3 , Cesar Santis  3   13   14 , Lauriane Degravi  5 , Maxens Decavèle  5   2 , Laurent Brochard  3   4 , Alexandre Demoule  5   2
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Free article

Dyspnoea and respiratory muscle ultrasound to predict extubation failure

Martin Dres et al. Eur Respir J. .
Free article

Abstract

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 versus success: 7 (4-9) versus 3 (1-5) (p<0.001) and 3.7 (1.8-5.8) versus 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) versus 0.3 (0.2-0.5) (p<0.001) and 45 (36-50) versus 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.

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Conflict of interest statement

Conflict of interest: M. Dres reports personal fees from Lungpacer SA, outside the submitted work. Conflict of interest: T. Similowski reports personal fees from AstraZeneca France, Boehringer Ingelheim France, GSK France, Teva France, Chiesi France, Lungpacer Inc. and ADEP Assistance, personal fees and nonfinancial support from Novartis France, grants from Air Liquide Medical Systems, outside the submitted work. Conflict of interest: E.C. Goligher reports personal fees and nonfinancial support (research equipment) from Getinge, nonfinancial support (research equipment) from Timpel, outside the submitted work. Conflict of interest: T. Pham has nothing to disclose. Conflict of interest: L. Sergenyuk has nothing to disclose. Conflict of interest: I. Telias reports grants from CIHR, personal fees for lectures from MBMed SA, Argentina and Covidien, Argentina, outside the submitted work. Conflict of interest: D.L. Grieco reports grants from GE, nonfinancial support from Dimar, Maquet and Fisher & Paykel, outside the submitted work. Conflict of interest: W. Ouechani has nothing to disclose. Conflict of interest: D. Junhasavasdikul has nothing to disclose. Conflict of interest: M.C. Sklar has nothing to disclose. Conflict of interest: L.F. Damiani has nothing to disclose. Conflict of interest: L. Melo has nothing to disclose. Conflict of interest: C. Santis has nothing to disclose. Conflict of interest: L. Degravi has nothing to disclose. Conflict of interest: M. Decavèle has nothing to disclose. Conflict of interest: L. Brochard reports grants from Medtronic Covidien, grants and nonfinancial support from Fisher & Paykel, nonfinancial support from Sentec and Philips, other (patent) from General Electric, outside the submitted work. Conflict of interest: A. Demoule reports personal fees from Medtronic, Baxter, Hamilton, Getinge and Lowenstein, grants, personal fees and nonfinancial support from Philips, Respinor and Lungpacer, personal fees and nonfinancial support from Fisher & Paykel, grants from French Ministry of Health, outside the submitted work.

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