Acute and Critical Care

Original Articles

Pulmonary
The role of ROX index–based intubation in COVID-19 pneumonia: a cross-sectional comparison and retrospective survival analysis: Sara Vergis, Sam Philip, Vergis Paul, Manjit George, Nevil C Philip, Mithu Tomy; Acute Crit Care. 2023;38(2):182-189. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.00206

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Abstract PDF: Background
Coronavirus disease 2019 (COVID-19) patients with acute respiratory failure who experience delayed initiation of invasive mechanical ventilation have poor outcomes. The lack of objective measures to define the timing of intubation is an area of concern. We investigated the effect of timing of intubation based on respiratory rate-oxygenation (ROX) index on the outcomes of COVID-19 pneumonia. Methods: This was a retrospective cross-sectional study performed in a tertiary care teaching hospital in Kerala, India. Patients with COVID-19 pneumonia who were intubated were grouped into early intubation (within 12 hours of ROX index <4.88) or delayed intubation (12 hours or more hours after ROX <4.88). Results: A total of 58 patients was included in the study after exclusions. Among them, 20 patients were intubated early, and 38 patients were intubated 12 hours after ROX index <4.88. The mean age of the study population was 57±14 years, and 55.0% of the patients were male; diabetes mellitus (48.3%) and hypertension (50.0%) were the most common comorbidities. The early intubation group had 88.2% successful extubation, while only 11.8% of the delayed group had successful extubation (P<0.001). Survival was also significantly more frequent in the early intubation group. Conclusions: Early intubation within 12 hours of ROX index <4.88 was associated with improved extubation and survival in patients with COVID-19 pneumonia.

Pulmonary
Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index: Mohammad Jhahidul Alam, Simanta Roy, Mohammad Azmain Iktidar, Fahmida Khatun Padma, Khairul Islam Nipun, Sreshtha Chowdhury, Ranjan Kumar Nath, Harun-Or Rashid; Acute Crit Care. 2022;37(1):94-100. Published online January 11, 2022; DOI: https://doi.org/10.4266/acc.2021.01354

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Background
In 3%–19% of patients, reintubation is needed 48–72 hours following extubation, which increases intensive care unit (ICU) morbidity, mortality, and expenses. Extubation failure is frequently caused by diaphragm dysfunction. Ultrasonography can be used to determine the mobility and thickness of the diaphragm. This study looked at the role of diaphragm excursion (DE) and thickening fraction in predicting successful extubation from mechanical ventilation.
Methods
Thirty-one patients were extubated with the advice of an ICU consultant using the ICU weaning regimen and diaphragm ultrasonography was performed. Ultrasound DE and thickening fraction were measured three times: at the commencement of the t-piece experiment, at 10 minutes, and immediately before extubation. All patients' parameters were monitored for 48 hours after extubation. Rapid shallow breathing index (RSBI) was also measured at the same time.
Results
Successful extubation was significantly correlated with DE (P=0.01). Receiver curve analysis for DE to predict successful extubation revealed good properties (area under the curve [AUC], 0.83; P<0.001); sensitivity, 77.8%; specificity, 84.6%, positive predictive value (PPV), 87.5%; negative predictive value (NPV), 73.3% while cut-off value, 11.43 mm. Diaphragm thickening fraction (DTF) also revealed moderate curve properties (AUC, 0.69; P=0.06); sensitivity, 61.1%; specificity, 84.6%; PPV, 87.5%; NPV, 61.1% with cut-off value 22.33% although former one was slightly better. RSBI could not reach good receiver operating characteristic value at cut-off points 100 b/min/L (AUC, 0.58; P=0.47); sensitivity, 66.7%; specificity, 53.8%; PPV, 66.7%; NPV, 53.8%).
Conclusions
To decrease the rate of reintubation, DE and DTF are better indicators of successful extubation. DE outperforms DTF.

Citations

Citations to this article as recorded by

Rapid shallow breathing index predicting extubation outcomes: A systematic review and meta-analysis
Donghui Jia, Hengyang Wang, Qian Wang, Wenrui Li, Xuhong Lan, Hongfang Zhou, Zhigang Zhang
Intensive and Critical Care Nursing.2024; 80: 103551. CrossRef
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
The Role of Ultrasonography in the Process of Weaning from Mechanical Ventilation in Critically Ill Patients
Lou’i Al-Husinat, Basil Jouryyeh, Ahlam Rawashdeh, Chiara Robba, Pedro Silva, Patricia Rocco, Denise Battaglini
Diagnostics.2024; 14(4): 398. CrossRef
Critical illness-associated limb and diaphragmatic weakness
Valentine Le Stang, Nicola Latronico, Martin Dres, Michele Bertoni
Current Opinion in Critical Care.2024; 30(2): 121. 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 Assessment of Diaphragmatic Function and Its Clinical Application in the Management of Patients with Acute Respiratory Failure
Marina Saad, Stefano Pini, Fiammetta Danzo, Francesca Mandurino Mirizzi, Carmine Arena, Francesco Tursi, Dejan Radovanovic, Pierachille Santus
Diagnostics.2023; 13(3): 411. CrossRef
The ratio of respiratory rate to diaphragm thickening fraction for predicting extubation success
Dararat Eksombatchai, Chalermwut Sukkratok, Yuda Sutherasan, Detajin Junhasavasdikul, Pongdhep Theerawit
BMC Pulmonary Medicine.2023;[Epub] CrossRef
Effectiveness of diaphragmatic ultrasound as a predictor of successful weaning from mechanical ventilation: a systematic review and meta-analysis
Henry M. Parada-Gereda, Adriana L. Tibaduiza, Alejandro Rico-Mendoza, Daniel Molano-Franco, Victor H. Nieto, Wanderley A. Arias-Ortiz, Purificación Perez-Terán, Joan R. Masclans
Critical Care.2023;[Epub] CrossRef
Value of Diaphragm Ultrasonography for Extubation: A Single-Blinded Randomized Clinical Trial
T. G. Toledo, M. R. Bacci, Fred A. Luchette
Critical Care Research and Practice.2023; 2023: 1. CrossRef
Role of diaphragm ultrasound in weaning mechanically ventilated patients: A prospective observational study
Ravi Saravanan, Krishnamurthy Nivedita, Krishnamoorthy Karthik, Rajagopalan Venkatraman
Indian Journal of Anaesthesia.2022; 66(8): 591. CrossRef
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 and Critical Care.2022; 37(3): 347. CrossRef
Diaphragm ultrasound in weaning from mechanical ventilation: a last step to predict successful extubation?
Domenica Di Costanzo, Mariano Mazza, Antonio Esquinas
Acute and Critical Care.2022; 37(4): 681. CrossRef
Sonographic assessment of diaphragmatic thickening and excursion as predictors of weaning success in the intensive care unit: A prospective observational study
Amandeep Kaur, Shruti Sharma, VikramP Singh, MRavi Krishna, ParshotamL Gautam, Gagandeep Singh
Indian Journal of Anaesthesia.2022; 66(11): 776. CrossRef
Comparison of assessment of diaphragm function using speckle tracking between patients with successful and failed weaning: a multicentre, observational, pilot study
Qiancheng Xu, Xiao Yang, Yan Qian, Chang Hu, Weihua Lu, Shuhan Cai, Bo Hu, Jianguo Li
BMC Pulmonary Medicine.2022;[Epub] CrossRef
Ultrasonographic assessment of diaphragmatic function in preterm infants on non-invasive neurally adjusted ventilatory assist (NIV-NAVA) compared to nasal intermittent positive-pressure ventilation (NIPPV): a prospective observational study
Mohamed Elkhouli, Liran Tamir-Hostovsky, Jenna Ibrahim, Nehad Nasef, Adel Mohamed
European Journal of Pediatrics.2022; 182(2): 731. CrossRef

Pulmonary
Predictive value of the negative inspiratory force index as a predictor of weaning success: a crosssectional study: Phuong Hoang Vu, Viet Duc Tran, Minh Cuong Duong, Quyet Thang Cong, Thu Nguyen; Acute Crit Care. 2020;35(4):279-285. Published online November 30, 2020; DOI: https://doi.org/10.4266/acc.2020.00598

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Abstract PDF

Background
Identifying when intubated patients are ready to be extubated remains challenging. The negative inspiratory force (NIF) is a recommended predictor of weaning success. However, little is known about the role of NIF in the weaning process for the Asian surgical intensive population, especially for the Vietnamese population. Here, we aimed to investigate the cutoff threshold and predictive value of the NIF index for predicting the success of ventilator weaning in Vietnamese surgical intensive care patients.
Methods
A cross-sectional study was conducted at the Surgical Intensive Care Unit of Viet Duc Hospital from October 2016 to August 2017. A total of 64 patients aged 16–70 years undergoing ventilatory support through an orotracheal tube satisfied the criteria for readiness to begin weaning. The correlation between the NIF index with outcomes of the weaning process was analyzed. Specificity (Sp), sensitivity (Se), positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristic (ROC) curve, and area under the curve (AUC) were calculated.
Results
The success rate of the entire weaning process was 67.2% (43/64). The median NIF values were –26.0 cm H₂O (interquartile range [IQR], –28.0 to –25.0) in the successful weaning group and –24.0 cm H₂O (IQR, –25.0 to –23.0) in the weaning failure group (P<0.001). According to ROC analysis, an NIF value ≤–25 cm H₂O predicted weaning success (AUC, 0.836) with 91% Se, 62% Sp, 83% PPV, and 77% NPV.
Conclusions
An NIF cutoff threshold ≤–25 cm H₂O can be used as predictor of weaning success in Vietnamese surgical intensive care patients.

Citations

Citations to this article as recorded by

Pendelluft as a predictor of weaning in critically ill patients: An observational cohort study
Danqiong Wang, Yaxin Ning, Linya He, Keqi Pan, Xiaohua Xiong, Shanshan Jing, Jianhua Hu, Jian Luo, Dehua Ye, Zubing Mei, Weiwen Zhang
Frontiers in Physiology.2023;[Epub] CrossRef
Morphological and Functional Alterations of Respiratory Muscle Performance and Spirometry Parameters in Patients with Congestive Heart Failure
V. S. Shabaev, I. V. Orazmagomedova, V. A. Mazurok, A. V. Berezina, A. E. Bautin, L. G. Vasilyeva, D. A. Aleksandrova
General Reanimatology.2023; 19(5): 39. CrossRef
Diaphragmatic dysfunction in patients with chronic heart failure
V.S. Shabaev, I.V. Orazmagomedova, V.A. Mazurok, A.V. Berezina, A.E. Bautin, L.G. Vasilyeva, D.A. Aleksandrova
Anesteziologiya i reanimatologiya.2023; (5): 44. CrossRef
Biosignal-Based Digital Biomarkers for Prediction of Ventilator Weaning Success
Ji Eun Park, Tae Young Kim, Yun Jung Jung, Changho Han, Chan Min Park, Joo Hun Park, Kwang Joo Park, Dukyong Yoon, Wou Young Chung
International Journal of Environmental Research and Public Health.2021; 18(17): 9229. CrossRef

Epidemiology
Postextubation respiratory events in patients admitted to the intensive care unit: a prospective pilot study using overnight respiratory polygraphy: Ye Jin Lee, Jinwoo Lee, Sang-Min Lee, Jaeyoung Cho; Acute Crit Care. 2020;35(4):271-278. Published online November 12, 2020; DOI: https://doi.org/10.4266/acc.2020.00479

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Abstract PDF Supplementary Material

Background
Before the main trial in which respiratory polygraphy will be used to evaluate postextubation sleep apnea in critically ill patients, we performed a prospective pilot study to ensure that any issues with the conduct of the trial would be identified.
Methods
In the present study, 13 adult patients who had received mechanical ventilation for ≥24 hours were prospectively recruited. Among the patients, 10 successfully completed respiratory polygraphy on the first or second night after extubation. Data regarding the types and doses of corticosteroids, analgesics, sedatives, and muscle relaxants as well as the methods of oxygen delivery were recorded.
Results
During the night of respiratory polygraphy, all 10 patients received supplemental oxygen (low-flow oxygen, n=5; high-flow oxygen, n=5), and seven patients received intravenous corticosteroids. Three of the 10 patients had a respiratory event index (REI) ≥5/hr. All respiratory events were obstructive episodes. None of the patients receiving high-flow oxygen therapy had an REI ≥5/hr. Two of the seven patients who received corticosteroids and one of the other three patients who did not receive this medication had an REI ≥5/hr. Although low- or high-flow oxygen therapy was provided, all patients had episodes of oxygen saturation (SpO2) <90%. Two of the three patients with an REI ≥5/hr underwent in-laboratory polysomnography. The patients’ Apnea-Hypopnea Index and REI obtained via polysomnography and respiratory polygraphy, respectively, were similar.
Conclusions
In a future trial to evaluate postextubation sleep apnea in critically ill patients, pre-stratification based on the use of corticosteroids and high-flow oxygen therapy should be considered.

Citations

Citations to this article as recorded by

Sleep assessment in critically ill adults: A systematic review and meta-analysis
Ellaha Kakar, Matthijs Priester, Pascale Wessels, Arjen J.C. Slooter, M. Louter, M. van der Jagt
Journal of Critical Care.2022; 71: 154102. CrossRef

Pulmonary
Protecting Postextubation Respiratory Failure and Reintubation by High-Flow Nasal Cannula Compared to Low-Flow Oxygen System: Single Center Retrospective Study and Literature Review: Minhyeok Lee, Ji Hye Kim, In Beom Jeong, Ji Woong Son, Moon Jun Na, Sun Jung Kwon; Acute Crit Care. 2019;34(1):60-70. Published online February 28, 2019; DOI: https://doi.org/10.4266/acc.2018.00311

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2 Crossref

Abstract PDF Supplementary Material

Background
Use of a high-flow nasal cannula (HFNC) reduced postextubation respiratory failure (PERF) and reintubation rate compared to use of a low-flow oxygen system (LFOS) in low-risk patients. However, no obvious conclusion was reached for high-risk patients. Here, we sought to present the current status of HFNC use as adjunctive oxygen therapy in a clinical setting and to elucidate the nature of the protective effect following extubation.
Methods
The medical records of 855 patients who were admitted to the intensive care unit of single university hospital during a period of 5.5 years were analyzed retrospectively, with only 118 patients ultimately included in the present research. The baseline characteristics of these patients and the occurrence of PERF and reintubation along with physiologic changes were analyzed.
Results
Eighty-four patients underwent HFNC, and the remaining 34 patients underwent conventional LFOS after extubation. Physicians preferred HFNC to LFOS in the face of highrisk features including old age, neurologic disease, moderate to severe chronic obstructive pulmonary disease, a long duration of mechanical ventilation, low baseline arterial partial pressure of oxygen to fraction of inspired oxygen ratio, and a high baseline alveolar–arterial oxygen difference. The reintubation rate at 72 hours after extubation was not different (9.5% vs. 8.8%; P=1.000). Hypoxic respiratory failure was slightly higher in the nonreintubation group than in the reintubation group (31.9% vs. 6.7%; P=0.058). Regarding physiologic effects, heart rate was only stabilized after 24 hours of extubation in the HFNC group.
Conclusions
No difference was found in the occurrence of PERF and reintubation between both groups. It is worth noting that similar PERF and reintubation ratios were shown in the HFNC group in those with certain exacerbating risk factors versus not. Caution is needed regarding delayed reintubation in the HFNC group.

Citations

Citations to this article as recorded by

Predictors and outcomes of high-flow nasal cannula failure following extubation: A multicentre observational study
Amit Kansal, Shekhar Dhanvijay, Andrew Li, Jason Phua, Matthew Edward Cove, Wei Jun Dan Ong, Ser Hon Puah, Vicky Ng, Qiao Li Tan, Julipie Sumampong Manalansan, Michael Sharey Nocon Zamora, Michael Camba Vidanes, Juliet Tolentino Sahagun, Juvel Taculod, Ad
Annals of the Academy of Medicine, Singapore.2021; 50(6): 467. CrossRef
Flow Field Analysis of Adult High-Flow Nasal Cannula Oxygen Therapy
Jingen Xia, Jiaqi Chang, Jixiang Liang, Yixuan Wang, Na Wang, Bo Xiao
Complexity.2021; 2021: 1. CrossRef

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