ABSTRACT
Objetivo Evaluar la exactitud diagnóstica de la ecografía diafragmática para predecir el éxito en la extubación. Diseño Estudio de exactitud diagnóstica. Ámbito Unidad de Cuidado Intensivo Médico de un hospital académico de la ciudad de Bogotá (Colombia). Pacientes o participantes Muestra consecutiva de pacientes mayores de 18 años con ventilación mecánica invasiva durante más de 48h. Intervenciones Evaluación ecográfica diafragmática al finalizar la prueba de ventilación espontánea. Variables de interés principales Se evaluó la excursión diafragmática (ED, cm), el tiempo de inspiración (TPIAdia, s), la velocidad de contracción del diafragma (ED/TPIAdia, cm/s), el tiempo total (Ttot, s) y la fracción de engrosamiento (TFdi, %). Resultados Se incluyeron 84 pacientes, el 79,8% (n=67) con extubación exitosa y el 20,2% (n=17) con extubación fallida. La variable con mejor capacidad discriminatoria para predecir éxito en la extubación fue la velocidad de contracción, con un AUC-ROC de 0,70 (p=0,008). Conclusiones La velocidad de contracción diafragmática mostró una capacidad discriminatoria aceptable. La ultrasonografía podría formar parte de un abordaje multifactorial en el proceso de extubación. (AU)
Objective To evaluate the diagnostic accuracy of diaphragmatic ultrasound in predicting extubation success. Design A diagnostic accuracy study was carried out. Scope Intensive Care Unit of an Academic hospital in the city of Bogotá (Colombia). Patients or participants A consecutive sample of patients >18 years of age subjected to invasive mechanical ventilation for >48h. Interventions Diaphragmatic ultrasound evaluation at the end of spontaneous ventilation testing. Main variables of interest Diaphragmatic excursion (DE, cm), inspiration time (TPIAdia, s), diaphragm contraction speed (DE/TPIAdia, cm/s) and total time (Ttot, s) were evaluated, together with thickening fraction (TFdi, %). Results A total of 84 patients were included, 79.8% (n=67) with successful extubation and 20.2% (n=17) with failed extubation. The variable with the best discriminatory capacity in predicting extubation success was diaphragm contraction speed, with AUC-ROC 0.70 (p=0.008). Conclusions Diaphragm contraction speed exhibited acceptable discriminatory capacity. Ultrasound could be part of a multifactorial approach in the extubation process. (AU)
Subject(s)
Humans , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Critical Illness , Airway Extubation , Diaphragm , Diagnostic Imaging , Intensive Care Units , Respiration , Ultrasonography , Ventilator Weaning , ColombiaABSTRACT
OBJECTIVE: To evaluate the diagnostic accuracy of diaphragmatic ultrasound in predicting extubation success. DESIGN: A diagnostic accuracy study was carried out. SCOPE: Intensive Care Unit of an Academic hospital in the city of Bogotá (Colombia). PATIENTS OR PARTICIPANTS: A consecutive sample of patients >18 years of age subjected to invasive mechanical ventilation for >48h. INTERVENTIONS: Diaphragmatic ultrasound evaluation at the end of spontaneous ventilation testing. MAIN VARIABLES OF INTEREST: Diaphragmatic excursion (DE, cm), inspiration time (TPIAdia, s), diaphragm contraction speed (DE/TPIAdia, cm/s) and total time (Ttot, s) were evaluated, together with thickening fraction (TFdi, %). RESULTS: A total of 84 patients were included, 79.8% (n=67) with successful extubation and 20.2% (n=17) with failed extubation. The variable with the best discriminatory capacity in predicting extubation success was diaphragm contraction speed, with AUC-ROC 0.70 (p=0.008). CONCLUSIONS: Diaphragm contraction speed exhibited acceptable discriminatory capacity. Ultrasound could be part of a multifactorial approach in the extubation process.
