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Observational Study
. 2022 Aug 21;23(1):210.
doi: 10.1186/s12931-022-02138-y.

Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study

Luigi Vetrugno  1   2 , Daniele Orso  3   4 , Francesco Corradi  5 , Gianluca Zani  6 , Savino Spadaro  7 , Francesco Meroi  3   4 , Natascia D'Andrea  3   4 , Tiziana Bove  3   4 , Gianmaria Cammarota  8   9 , Edoardo De Robertis  8   9 , Samuele Ferrari  5 , Marcello Guarnieri  10 , Margherita Ajuti  10 , Maurizio Fusari  6 , Domenico Luca Grieco  11 , Cristian Deana  4 , Enrico Boero  12 , Federico Franchi  13 , Sabino Scolletta  13 , Salvatore Maurizio Maggiore  14   15 , Francesco Forfori  5
Affiliations
Observational Study

Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study

Luigi Vetrugno et al. Respir Res. .

Abstract

Background: Diaphragmatic dysfunction is a major factor responsible for weaning failure in patients that underwent prolonged invasive mechanical ventilation for acute severe respiratory failure from COVID-19. This study hypothesizes that ultrasound measured diaphragmatic thickening fraction (DTF) could provide corroborating information for weaning COVID-19 patients from mechanical ventilation.

Methods: This was an observational, pragmatic, cross-section, multicenter study in 6 Italian intensive care units. DTF was assessed in COVID-19 patients undergoing weaning from mechanical ventilation from 1st March 2020 to 30th June 2021. Primary aim was to evaluate whether DTF is a predictive factor for weaning failure.

Results: Fifty-seven patients were enrolled, 25 patients failed spontaneous breathing trial (44%). Median length of invasive ventilation was 14 days (IQR 7-22). Median DTF within 24 h since the start of weaning was 28% (IQR 22-39%), RASS score (- 2 vs - 2; p = 0.031); Kelly-Matthay score (2 vs 1; p = 0.002); inspiratory oxygen fraction (0.45 vs 0.40; p = 0.033). PaO2/FiO2 ratio was lower (176 vs 241; p = 0.032) and length of intensive care stay was longer (27 vs 16.5 days; p = 0.025) in patients who failed weaning. The generalized linear regression model did not select any variables that could predict weaning failure. DTF was correlated with pH (RR 1.56 × 1027; p = 0.002); Kelly-Matthay score (RR 353; p < 0.001); RASS (RR 2.11; p = 0.003); PaO2/FiO2 ratio (RR 1.03; p = 0.05); SAPS2 (RR 0.71; p = 0.005); hospital and ICU length of stay (RR 1.22 and 0.79, respectively; p < 0.001 and p = 0.004).

Conclusions: DTF in COVID-19 patients was not predictive of weaning failure from mechanical ventilation, and larger studies are needed to evaluate it in clinical practice further. Registered: ClinicalTrial.gov (NCT05019313, 24 August 2021).

Keywords: COVID-19; Diaphragm; Mechanical ventilation; Ultrasound; Weaning failure.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
DTF comparison between successfully weaned patients and those who failed weaning from mechanical ventilation. Although DTF medians are not significantly different (28% vs 27.6%; p = 0.612), higher outliers are found in patients who failed weaning
Fig. 2
Fig. 2
DTF distribution, with respect to PaO2/FiO2, in successfully weaned patients (in blue) and unsuccessfully (in red). The trend was obtained through a mixed linear regression model, which demonstrates a U-shaped trend in DTF values, lowest PaO2/FiO2 values at both extremes, for patients who failed weaning
Fig. 3
Fig. 3
Comparison of SAPS-2 scores (x-axis) and DTF values (y-axis), divided by gender (females on the left and males on the right) and PaO2/FiO2 ratio subclasses (highest values in green, lowest in red). As shown in the lower right quadrants of the graphs (highest SAPS-2 scores) DTF values are higher in males, compared to females, for each PaO2/FiO2 subclass
See this image and copyright information in PMC

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