Newly Published
Critical Care Medicine  |   June 2017
Combined Thoracic Ultrasound Assessment during a Successful Weaning Trial Predicts Postextubation Distress
Author Notes
  • From the Critical Care Unit (S.S., D.A.A., L.H., F.F., D.R., A.M., B.R.) and Critical Care and Anaesthesiology Department (S.S., D.A.A., L.H., J.R., F.F., D.R., A.M., O.F., B.R.), University Teaching Hospital of Purpan, Toulouse, France; French National Institute of Health and Medical Research U1214, University Teaching Hospital of Purpan, Toulouse, France (S.S.); Critical Care Unit, Hopital Dieu Hospital, Narbonne, France (P.C., M.M., B.B.); Critical Care Unit, University Cancer Institute Hospital of Toulouse, France (J.R.); and Intensive Care Unit and Transplantation, Department of Anaesthesiology and Critical Care B, Saint Eloi Hospital, Montpellier, France (S.J.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication May 20, 2016. Accepted for publication May 17, 2017.
    Submitted for publication May 20, 2016. Accepted for publication May 17, 2017.×
  • Research Support: Support was provided solely from institutional departmental funds from the University Teaching Hospital of Toulouse, Toulouse, France. The funding sources had no role in the study design, data collection, data analysis, data interpretation, or writing of this report.
    Research Support: Support was provided solely from institutional departmental funds from the University Teaching Hospital of Toulouse, Toulouse, France. The funding sources had no role in the study design, data collection, data analysis, data interpretation, or writing of this report.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Silva: Critical Care Unit, Center Hospitalier Universitaire Purpan, 31059 Toulouse Cedex 3, France. silvastein@me.com or silva.s@chu-toulouse.fr. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Critical Care Medicine / Critical Care / Radiological and Other Imaging / Respiratory System
Critical Care Medicine   |   June 2017
Combined Thoracic Ultrasound Assessment during a Successful Weaning Trial Predicts Postextubation Distress
Anesthesiology Newly Published on June 29, 2017. doi:10.1097/ALN.0000000000001773
Anesthesiology Newly Published on June 29, 2017. doi:10.1097/ALN.0000000000001773
Abstract

Background: Recent studies suggest that isolated sonographic assessment of the respiratory, cardiac, or neuromuscular functions in mechanically ventilated patients may assist in identifying patients at risk of postextubation distress. The aim of the present study was to prospectively investigate the value of an integrated thoracic ultrasound evaluation, encompassing bedside respiratory, cardiac, and diaphragm sonographic data in predicting postextubation distress.

Methods: Longitudinal ultrasound data from 136 patients who were extubated after passing a trial of pressure support ventilation were measured immediately after the start and at the end of this trial. In case of postextubation distress (31 of 136 patients), an additional combined ultrasound assessment was performed while the patient was still in acute respiratory failure. We applied machine-learning methods to improve the accuracy of the related predictive assessments.

Results: Overall, integrated thoracic ultrasound models accurately predict postextubation distress when applied to thoracic ultrasound data immediately recorded before the start and at the end of the trial of pressure support ventilation (learning sample area under the curve: start, 0.921; end, 0.951; test sample area under the curve: start, 0.972; end, 0.920). Among integrated thoracic ultrasound data, the recognition of lung interstitial edema and the increased telediastolic left ventricular pressure were the most relevant predictive factors. In addition, the use of thoracic ultrasound appeared to be highly accurate in identifying the causes of postextubation distress.

Conclusions: The decision to attempt extubation could be significantly assisted by an integrative, dynamic, and fully bedside ultrasonographic assessment of cardiac, lung, and diaphragm functions.