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Original Article
Pulmonary
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
DOI: https://doi.org/10.4266/acc.2022.00108
  • 3,111 View
  • 217 Download
  • 2 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary Material
Background
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.
Methods
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.
Results
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.
Conclusions
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

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;[Epub]     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
Review
Pulmonary
Lung Ultrasound (in the Critically Ill) Superior to CT: the Example of Lung Sliding
Daniel A. Lichtenstein
Korean J Crit Care Med. 2017;32(1):1-8.   Published online February 14, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00955
  • 18,294 View
  • 858 Download
  • 11 Web of Science
  • 13 Crossref
AbstractAbstract PDF
This review article shows the potential of lung ultrasound in the critically ill (LUCI) to study lung sliding and describes the optimal equipment for its assessment. Then, it analyses the integration of lung sliding within lung ultrasound then whole body critical ultrasound. It describes the place of lung sliding in the BLUE-protocol (bedside lung ultrasound in emergency) (lung and venous ultrasound for diagnosing acute respiratory failure), the FALLS-protocol (fluid administration limited by lung sonography) (the role of lung sliding in circulatory failure), and the SESAME-protocol (sequential assessment of sonography assessing mechanism or origin of severe shock of indistinct cause) (whole body ultrasound in cardiac arrest). In the LUCIFLR project (LUCI favoring limitation of radiations), the consideration of lung sliding allows drastic reduction in irradiation and costs. In conclusion, lung sliding is proposed as a gold standard for indicating the presence of the lung at the chest wall and its correct expansion.

Citations

Citations to this article as recorded by  
  • Transthoracic needle biopsy for diagnosis of lung cancer
    Dongil Park
    Journal of the Korean Medical Association.2023; 66(3): 160.     CrossRef
  • Determinants of point-of-care ultrasound lung sliding amplitude in mechanically ventilated patients
    David N. Briganti, Christine E. Choi, Julien Nguyen, Charles W. Lanks
    The Ultrasound Journal.2023;[Epub]     CrossRef
  • Humán kadávermodell a légmell ágy melletti ultrahang-diagnosztikájához.
    Noémi Ádám, Gábor Orosz, Máté Berczi, Tamás Ruttkay
    Orvosi Hetilap.2023; 164(46): 1824.     CrossRef
  • Early detection of delayed pneumothorax using lung ultrasound after transthoracic needle lung biopsy: A prospective pilot study
    Jeong Suk Koh, Chaeuk Chung, Ju Ock Kim, Sung Soo Jung, Hee Sun Park, Jeong Eun Lee, Da Hyun Kang, Yoonjoo Kim, Dongil Park
    The Clinical Respiratory Journal.2022; 16(5): 413.     CrossRef
  • Usefulness of Lung Ultrasound Follow‐up in Patients Who Have Recovered From Coronavirus Disease 2019
    Yale Tung‐Chen, Milagros Martí de Gracia, Maria Luz Parra‐Gordo, Aurea Díez‐Tascón, Sergio Agudo‐Fernández, Silvia Ossaba‐Vélez
    Journal of Ultrasound in Medicine.2021; 40(9): 1971.     CrossRef
  • The role of lung ultrasound in COVID-19 disease
    Dirk-André Clevert, Paul S. Sidhu, Adrian Lim, Caroline Ewertsen, Vladimir Mitkov, Maciej Piskunowicz, Paolo Ricci, Núria Bargallo, Adrian P. Brady
    Insights into Imaging.2021;[Epub]     CrossRef
  • Point-of-Care Ultrasound in Acute Care Nephrology
    Nithin Karakala, Daniel Córdoba, Kiran Chandrashekar, Arnaldo Lopez-Ruiz, Luis A. Juncos
    Advances in Chronic Kidney Disease.2021; 28(1): 83.     CrossRef
  • YEARS Algorithm Versus Wells’ Score: Predictive Accuracies in Pulmonary Embolism Based on the Gold Standard CT Pulmonary Angiography*
    Ahmed Abdelaal Ahmed Mahmoud M. Alkhatip, Maria Donnelly, Lindi Snyman, Patrick Conroy, Mohamed Khaled Hamza, Ian Murphy, Andrew Purcell, David McGuire
    Critical Care Medicine.2020; 48(5): 704.     CrossRef
  • Sonographische Bildgebung der Lunge bei COVID-19
    M. Schmid, F. Escher, D.-A. Clevert
    Der Radiologe.2020; 60(10): 919.     CrossRef
  • Lung Ultrasound in Critical Care
    Maddani Shanmukhappa Sagar, Souvik Chaudhuri, Vedaghosh Amara, Sirish Gauni, Tushar Mittal
    Indian Journal of Respiratory Care.2020; 9(2): 141.     CrossRef
  • Current Misconceptions in Lung Ultrasound
    Daniel A. Lichtenstein
    Chest.2019; 156(1): 21.     CrossRef
  • Role of thoracic ultrasound in children with chronic kidney disease
    SaneyaAbd El-Halim Fahmy, NaglaaAbd El-Moneam Abd Allah, AmiraI Al-Masry, Eman Sobh
    The Scientific Journal of Al-Azhar Medical Faculty, Girls.2019; 3(3): 693.     CrossRef
  • Novel approaches to ultrasonography of the lung and pleural space: where are we now?
    Daniel Lichtenstein
    Breathe.2017; 13(2): 100.     CrossRef
Case Reports
Airway Obstruction and Respiratory Failure Due to Aspergillus Tracheobronchitis
Yousang Ko, So Yeon Lim, Gee Young Suh, Kyeongman Jeon, Seo Goo Han
Korean J Crit Care Med. 2013;28(1):67-71.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.67
  • 2,656 View
  • 37 Download
  • 1 Crossref
AbstractAbstract PDF
Invasive aspergillosis is a serious threat and a leading cause of death in immunocompromised patients. Aspergillus tracheobronchitis is an infrequent but severe form of invasive pulmonary aspergillos in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We report an extraordinary case of acute airway obstruction and respiratory failure due to Aspergillus tracheobronchitis in an immunocompromised patient. Fiberoptic bronchoscopy revealed extensive obstruction of both the main and lobar bronchus with yellowish nodules strongly adhered to the bronchial wall; both histologic examination and culture of these nodules revealed Aspergillus fumigatus. Even with early detection of an intraluminal growth of Aspergillus and prompt institution of antifungal therapy, the patient died of refractory hypoxemia a few days later. This report shows that Aspergillus tracheobronchitis should be considered in immunocompromised patients with suspected lung infection even when the main radiographic finding is atelectasis.

Citations

Citations to this article as recorded by  
  • Death due to Aspergillus Tracheobronchitis: An Autopsy Case
    Tack Kune You, Byung Ha Choi, Bong Woo Lee, Young Shik Choi
    Korean Journal of Legal Medicine.2018; 42(4): 164.     CrossRef
Acute Respiratory Failure from Invasive Pulmonary Aspergillosis in an Immunocompetent Adult: A Case Report
Jong Sun Park, Jae Joon Yim, Seok Chul Yang, Chul Gyu Yoo, Young Whan Kim, Sung Koo Han, Young Soo Shim, Sang Min Lee
Korean J Crit Care Med. 2009;24(3):172-175.
DOI: https://doi.org/10.4266/kjccm.2009.24.3.172
  • 2,526 View
  • 33 Download
AbstractAbstract PDF
Invasive pulmonary aspergillosis has traditionally been known as a disease of an immunocompromised host. We report here on a case of an immunocompetent 73-year-old male who presented with dyspnea and he was finally diagnosed as suffering with invasive pulmonary aspergillosis. He died from progressive respiratory failure and secondary bacterial sepsis despite of voriconazole treatment. Invasive pulmonary aspergillosis should be considered as one of the differential diagnoses in patients with atypical pneumonia that does not respond to the usual antibiotics therapy, and even if the patient does not have an obvious history of an immunosuppressive status. An early suspicion with prompt treatment is important to improve the patient outcome.
Successful Application of Extracorporeal Membrane Oxygenation for 3 Patients in Medical Intensive Care Unit: Case Report
Hye Yun Park, Eun Hae Kang, Hyo Kyoung Choi, Gee Young Suh, O Jung Kwon, Kiick Sung, Young Tak Lee
Korean J Crit Care Med. 2007;22(2):91-95.
  • 2,270 View
  • 101 Download
AbstractAbstract PDF
Extracorporeal membrane oxygenation (ECMO) is a life-sustaining salvage therapy applied to the patient with acute heart failure or respiratory failure which is considered curable, but uncorrectable by conventional means. Recently, accumulating data has shown the survival benefit of ECMO in patients with acute fatal cardiopulmonary decompensation. Here, we report a series of cases of successful ECMO treatment in patients with acute cardiopulmonary insufficiency. Case 1: A patient with progressive respiratory failure on mechanical ventilation after pneumonectomy was managed satisfactorily using a veno-venous ECMO. Case 2: A veno-arterial ECMO was used to support a patient with vasopressor refractory septic shock. After 5 days of treatment, the patient was successfully weaned from ECMO. Case 3: A patient in cardiac arrest after the orthopedic surgery was resuscitated using a veno-arterial ECMO. Pulmonary angiography on ECMO revealed massive pulmonary thromboembolism and embolectomy was thoroughly performed under the support of ECMO.

ACC : Acute and Critical Care