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Medicina crítica (Colegio Mexicano de Medicina Crítica)
versão impressa ISSN 2448-8909
Resumo
DELGADO AYALA, Lucia Yunuen et al. Prediction of successfull weaning in invasive mechanically ventilated patients using lung ultrasound. Med. crít. (Col. Mex. Med. Crít.) [online]. 2016, vol.30, n.3, pp.153-160. Epub 30-Ago-2021. ISSN 2448-8909.
Despite conducting appropriate spontaneous testing, 10-20% of patients under IMV fail weaning, increasing morbidity and mortality.
Objectives:
Evaluation of lung ultrasound (LUS) to predict extubation failure.
Methods:
Prospective observational study from April 2013 to 2015. Inclusion: patients ≥ 18 years, ≥ 24 hours under invasive mechanical ventilation (IMV) that met extubation international consensus criteria (EICI). Exclusion: ≤ 18 years or those in order to limit the therapeutic effort. Discontinuation of IMV was decided under clinical judgment of medical team, according to EICI. The setting of the ventilator was in SPV, (PS) 7 cmH2O CPAP 0, FiO2 35% for 30 minutes to assess the presence of lung lines. It was classified into patterns A, B or AB in the first minute and at 30 minutes. Weaning was considered successful if spontaneous breathing was maintained for ≥ 48 hrs. Successful extubation (Group A), Group B: weaning failure. Statistical analysis: Excel data collection and statistical analysis with SPSS version 16.0. A p value ≤ 0.05 was considered significant.
Results:
80 patients were analyzed. The LUS in the first minute with a sensitivity 81%, specificity 60%, AUC 0.703 (CI 95%, 0.549-0.857), p = 0.031; LUS 30 minutes with a sensitivity 81%, specificity 50%, AUC 0.688 (CI 95%, 0.523-0.852), p = 0.046.
Conclusions:
LUS at the first minute is a promising index for predicting successful extubation. This new index, consisting of qualitative and quantitative variables, needs to be further validation.
Palavras-chave : Lung ultrasound; pressure support ventilation; continuous positive pressure airway; invasive mechanical ventilation; rapid shallow breathing index; vital capacity; pulmonary pattern A; pattern B lung; pulmonary pattern AB.
