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1 "Lokesh Kumar Lalwani"
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Original Article
The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience
Lokesh Kumar Lalwani, Manjunath B Govindagoudar, Pawan Kumar Singh, Mukesh Sharma, Dhruva Chaudhry
Acute Crit Care. 2022;37(3):347-354.   Published online July 25, 2022
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AbstractAbstract PDFSupplementary Material
Acute respiratory failure (ARF) is commonly managed with invasive mechanical ventilation (IMV). The majority of the time that a patient spends on IMV is in the process of weaning. Prediction of the weaning outcome is of paramount importance, as untimely/delayed extubation is associated with a high risk of mortality. Diaphragmatic ultrasonography is a promising tool in the intensive care unit, and its utility in predicting the success of weaning remains understudied.
In this prospective-observational study, we recruited 54 ARF patients on IMV, along with 50 healthy controls. During a spontaneous breathing trial, all subjects underwent diaphragmatic ultrasonography along with a rapid shallow breathing index (RSBI) assessment.
The mean age was 41.8±17.0 and 37.6±10.5 years among the cases and control group, respectively. Demographic variables were broadly similar in the two groups. The most common cause of ARF was obstructive airway disease. The average duration of IMV was 5.41±2.81 days. Out of 54 subjects, 45 were successfully weaned, while nine patients failed weaning. Age, body mass index, and severity of disease were similar in the successful and failed weaning patients. The sensitivity in predicting successful weaning of percent change in diaphragmatic thickness (Δtdi%) >29.71% was high (93.33%), while specificity was 66.67%. The sensitivity and specificity of mean diaphragmatic thickness (tdi) end-expiratory >0.178 cm was 60.00% and 77.78%, respectively. RSBI at 1 minute of <93.75 had an equally high sensitivity (93.33%) but a lower specificity (22.22%). Similar results were also found for RSBI measured at 5 minutes.
During the weaning assessment, the purpose is to minimize both premature as well as delayed extubation. We found that diaphragmatic ultrasonography, in particular Δtdi%, is better than RSBI in predicting weaning outcomes.


Citations to this article as recorded by  
  • Ultrasonography to Access Diaphragm Dysfunction and Predict the Success of Mechanical Ventilation Weaning in Critical Care
    Marta Rafael Marques, José Manuel Pereira, José Artur Paiva, Gonzalo García de Casasola‐Sánchez, Yale Tung‐Chen
    Journal of Ultrasound in Medicine.2024; 43(2): 223.     CrossRef
  • Accuracy of respiratory muscle assessments to predict weaning outcomes: a systematic review and comparative meta-analysis
    Diego Poddighe, Marine Van Hollebeke, Yasir Qaiser Choudhary, Débora Ribeiro Campos, Michele R. Schaeffer, Jan Y. Verbakel, Greet Hermans, Rik Gosselink, Daniel Langer
    Critical Care.2024;[Epub]     CrossRef
  • Ultrasonographic evaluation of diaphragm thickness and excursion: correlation with weaning success in trauma patients: prospective cohort study
    Golnar Sabetian, Mandana Mackie, Naeimehossadat Asmarian, Mahsa Banifatemi, Gregory A. Schmidt, Mansoor Masjedi, Shahram Paydar, Farid Zand
    Journal of Anesthesia.2024; 38(3): 354.     CrossRef
  • Diaphragmatic ultrasound: A new frontier in weaning from mechanical ventilation
    Manoj Kamal, Saikat Sengupta
    Indian Journal of Anaesthesia.2023; 67(Suppl 4): S205.     CrossRef

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