The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Comparison of clinical utility between diaphragm excursion and thickening change using ultrasonography to predict extubation success

  • Yoo, Jung-Wan (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Seung Jun (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gyeongsang National University Hospital) ;
  • Lee, Jong Deog (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gyeongsang National University Hospital) ;
  • Kim, Ho Cheol (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gyeongsang National University Hospital)
  • Received : 2016.05.12
  • Accepted : 2016.10.13
  • Published : 2018.03.01
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Abstract

Background/Aims: Both diaphragmatic excursion and change in muscle thickening are measured using ultrasonography (US) to assess diaphragm function and mechanical ventilation weaning outcomes. However, which parameter can better predict successful extubation remains to be determined. The aim of this study was to compare the clinical utility of these two diaphragmatic parameters to predict extubation success. Methods: This study included patients subjected to extubation trial in the medical or surgical intensive care unit of a university-affiliated hospital from May 2015 through February 2016. Diaphragm excursion and percent of thickening change (${\Delta}tdi%$tdi%) were measured using US within 24 hours before extubation. Results: Sixty patients were included, and 78.3% (47/60) of these patients were successfully extubated, whereas 21.7% (13/60) were not. The median degree of excursion was greater in patients with extubation success than in those with extubation failure (1.65 cm vs. 0.8 cm, p < 0.001). Patients with extubation success had a greater ${\Delta}tdi%$ than those with extubation failure (42.1% vs. 22.5%, p = 0.03). The areas under the receiver operating curve for excursion and ${\Delta}tdi%$ were 0.836 (95% confidence interval [CI], 0.717 to 0.919) and 0.698 (95% CI, 0.566 to 0.810), respectively (p = 0.017). Conclusions: Diaphragm excursion seems more accurate than a change in the diaphragm thickness to predict extubation success.

Keywords

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