Journal Article

Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study

Scolletta, Sabino, Cammarota, Gianmaria, Orso, Daniele, Deana, Cristian, Maggiore, Salvatore Maurizio, Ajuti, Margherita, De Robertis, Edoardo, D’Andrea, Natascia, Guarnieri, Marcello, Fusari, Maurizio, Vetrugno, Luigi, Grieco, Domenico Luca, Meroi, Francesco, Boero, Enrico, Corradi, Francesco, Zani, Gianluca, Ferrari, Samuele, Bove, Tiziana, Franchi, Federico, Spadaro, Savino, Forfori, Francesco

2022

Overview

Background Diaphragmatic dysfunction is a major factor responsible for weaning failure in patients that underwent prolonged invasive mechanical ventilation for acute severe respiratory failure from COVID-19. This study hypothesizes that ultrasound measured diaphragmatic thickening fraction (DTF) could provide corroborating information for weaning COVID-19 patients from mechanical ventilation. Methods This was an observational, pragmatic, cross-section, multicenter study in 6 Italian intensive care units. DTF was assessed in COVID-19 patients undergoing weaning from mechanical ventilation from 1st March 2020 to 30th June 2021. Primary aim was to evaluate whether DTF is a predictive factor for weaning failure. Results Fifty-seven patients were enrolled, 25 patients failed spontaneous breathing trial (44%). Median length of invasive ventilation was 14 days (IQR 7–22). Median DTF within 24 h since the start of weaning was 28% (IQR 22–39%), RASS score (− 2 vs − 2; p = 0.031); Kelly-Matthay score (2 vs 1; p = 0.002); inspiratory oxygen fraction (0.45 vs 0.40; p = 0.033). PaO 2 /FiO 2 ratio was lower (176 vs 241; p = 0.032) and length of intensive care stay was longer (27 vs 16.5 days; p = 0.025) in patients who failed weaning. The generalized linear regression model did not select any variables that could predict weaning failure. DTF was correlated with pH (RR 1.56 × 10 27 ; p = 0.002); Kelly-Matthay score (RR 353; p < 0.001); RASS (RR 2.11; p = 0.003); PaO 2 /FiO 2 ratio (RR 1.03; p = 0.05); SAPS2 (RR 0.71; p = 0.005); hospital and ICU length of stay (RR 1.22 and 0.79, respectively; p < 0.001 and p = 0.004). Conclusions DTF in COVID-19 patients was not predictive of weaning failure from mechanical ventilation, and larger studies are needed to evaluate it in clinical practice further. Registered: ClinicalTrial.gov (NCT05019313, 24 August 2021).

• Publisher: BioMed Central,BioMed Central Ltd,Nature Publishing Group,BMC
• Subject: Anesthesia / Artificial respiration / Body temperature / Coronaviruses / COVID-19 / Cross-sections / Diaphragm / Evaluation / Failure / Health aspects / Heart rate / Hospitals / Hypoxemia / Intensive care / Intensive care units / Intubation / Length of stay / Mechanical ventilation / Medicine / Medicine & Public Health / Methods / Ostomy / Patients / Physiology / Pneumology/Respiratory System / Pneumonia / Regression analysis / Regression models / Respiration / Respiratory failure / Success / Thickening / Ultrasonic imaging / Ultrasound / Variables / Ventilation / Ventilator weaning / Ventilators / Weaning / Weaning failure