ABSTRACT
[This corrects the article DOI: 10.1186/s40560-018-0277-9.].
ABSTRACT
BACKGROUND: Weaning failure is a crucial hindrance in critically ill patients. Rapid shallow breathing index (RSBI), a well-known weaning index, has some limitations in predicting weaning outcomes. A new weaning index using point-of-care ultrasound with diaphragmic thickening fraction (DTF) has potential benefits for improving weaning success. The aim of this study was to evaluate the efficacy of a combination of DTF and RSBI for predicting successful weaning compared to RSBI alone. METHODS: This prospective study enrolled patients from the medical intensive care unit or ward who were using mechanical ventilation and readied for weaning. Patients underwent a spontaneous breathing trial (SBT) for 1 h, and then, both hemi-diaphragms were visualized in the zone of apposition using a 10-MHz linear probe. Diaphragm thickness was recorded at the end of inspiration and expiration which supposed the lung volume equal to total lung capacity (TLC) and residual volume (RV), respectively, and the DTF was calculated as a percentage from this formula: thickness at TLC minus thickness at RV divided by thickness at RV. In addition, RSBI was calculated at 1 min after SBT. Weaning failure was defined as the inability to maintain spontaneous breathing within 48 h. RESULTS: Of the 34 patients enrolled, the mean (± SD) age was 66.5 (± 13.5) years. There were 25 patients with weaning success, 9 patients in the weaning failure group. The receiver operating characteristic curves of right and left DTF and the RSBI for the prediction of successful weaning were 0.951, 0.700, and 0.709, respectively. The most accurate cutoff value for prediction of successful weaning was right DTF ≥ 26% (sensitivity of 96%, specificity of 68%, positive predictive value of 89%, negative predictive value of 86%). The combination of right DTF ≥ 26% and RSBI ≤ 105 increased specificity to 78% but slightly decreased sensitivity to 92%. Intra-observer correlation increased sharply to almost 0.9 in the first ten patients and slightly increased after that. CONCLUSIONS: Point-of-care ultrasound to assess diaphragm function has an excellent learning curve and helps physicians determine weaning readiness in critically ill patients. The combination of right DTF and RSBI greatly improved the accuracy for prediction of successful weaning compared to RSBI alone. TRIAL REGISTRATION: Thai Clinical Trials Registry, TCTR20171025001. Retrospectively registered on October 23, 2017.
ABSTRACT
BACKGROUND AND OBJECTIVE: A non-invasive test called Cardio-Ankle Vascular Index (CA VI) measures aortic stiffness, which is an early sign of atherosclerosis. Obstructive sleep apnea (OSA) has a close association with cardiovascular mortality and morbidity. We sought to assess the relationship between OSA and arterial stiffness. MATERIAL AND METHOD: Seventy-one patients with OSA (apnea-hypopnea index AHI ≥ 5, mean age 51.5 ± 14.1 years, 27 females) and 11 controls (AHI < 5, mean age 56.8 ± 11.8 years, 5 females) were enrolled in the study. In all subjects, arterial stiffness (CAVI) was performed and recorded along with blood pressure, pulse pressure of brachial arteries, and ankle arteries. RESULTS: The demographic data of the patients with OSA and controls were not significantly different. Subjects with OSA demonstrated higher values ofmean ankle artery pulse pressure than the controls (73.1 ± 14.6 vs. 59.6 ± 6.1 mmHg, respectively), but arterial stiffness and CAVI had no statistically significant difference (7.47 ± 1.68 vs. 7.25 ± 1.61, respectively). CONCLUSION: There was no relationship between arterial stiffness CAVI, and the presence of OSA. However; there was a significant association between ankle artery pulse pressure and the presence of OSA.
