ABSTRACT
Background@#Weaning failure is common in mechanically ventilated patients, and if ultrasound can predict weaning outcome remains controversial. The purpose of this study was to evaluate the diaphragmatic function (thickness and excursion) measured by ultrasound as a predictor of the extubation outcome. @*Methods@#We included 62 mechanically ventilated patients from the chest intensive care unit in this study. Sixty-two patients who successfully passed the spontaneous breathing trial (SBT) were enrolled. The transthoracic ultrasound of the diaphragm was performed during an SBT to the assess diaphragmatic function (excursion and thickness), and they were classified into the successful extubation group and the failed extubation group. @*Results@#There was a statistically significant increase in the successful extubation group in the diaphragmatic excursion and thickness fraction (p<0.001), a statistically significant negative correlation between the diaphragmatic function and the duration of the mechanical ventilation, and a statistically significant negative correlation between the diaphragmatic excursion and the Acute Physiology and Chronic Health Evaluation II. The diaphragmatic excursion cutoff value predictive of weaning was 1.25 cm, with a specificity of 82.1% and a sensitivity of 97.1% respectively, and the diaphragmatic thickness cut-off value predictive of weaning was 21.5%, with a specificity of 60.7% and a sensitivity of 91.2%, respectively. @*Conclusion@#The diaphragmatic ultrasonography was found to be a promising tool for predicting the extubation outcome for mechanically ventilated patients.
ABSTRACT
We evaluated relations between interleukins [IL] IL-6 and IL-10 and euthyroid sick syndrome [ESS] in patients with nonthyroidal illness [NTI]. Sixty patients and 20 healthy volunteers were recruited. The patients had either chronic kidney disease [CKD], congestive heart failure [CHF], or acute myocardial infarction [MI], distributed equally in 3 subgroups. Serum levels of IL-6 and IL-10, thyroid stimulating hormone [TSH], total T4, and T3 were determined. In the 60 patients with NTI, we detected a significantly lower T3 and T4 levels compared to controls, while TSH level was within the reference range. Also, IL-6 level was substantially higher than that in controls [P < .001] and correlated with T3 [r = -0.620, P < .001] and T4 [r = -0.267, P < .001]. Similarly was IL-10 level [P < .001] that correlated with T3 [r = -0.512, P < .001], but not with T4. The ILs correlated positively with each other [r = 0.770, P < .001]. Only IL-6 was a predictor of low T3 [P = .001]. The proportion of patients with subnormal T3, T4, and TSH levels was highest in those with MI along with greatest IL-6 and IL-10 levels compared to patients with CHF and CKD. Patients with CKD showed the least disturbance in IL-6 and IL-10 despite the lower levels of T3, T4, and TSH in a higher proportion of them compared to patients with CHF. The high frequency of ESS in patients with NTI may be linked to IL-6 and IL-10 alterations. Perturbation of IL-6, and not IL-10, might be involved in the pathogenesis of ESS along with other key players as suggested by our findings in CKD