ĐÁNH GIÁ VAI TRÒ CỦA SIÊU ÂM CƠ HOÀNH TRONG TIÊN LƯỢNG CAI THỞ MÁY

Abstract

Study objectives: Evaluation of diaphragmatic ultrasound in predicting mechanically ventilated weaning. Study subjects: 45 mechanically ventilated weaning patients at Bach Mai Intensive care center. Methods: Prospective, Descriptive study, patient’s data were collected at the time the patients had indication for entracheal extubation. The patients were put in semi-recumbent position, the mechanically ventilated measurements were collected when the patients were ventilated by PSV mode, diaphragmatic ultrasound was perfomed just before extubation when the patients were breathing spontaneously by endotracheal. Results: Analyte data of 45 patients, successful extubation rate was 73.3% (n=32), failed extubation rate was 26,7% (n=13), 18 patients had diaphragmatic dysfunction (40%), 27 patients had not diaphragmatic dysfunction (60%) Bilateral Diaphragmatic Excursion in Normal breath (DEN) and bilateral Diaphragmatic Thickness Fraction (DTF%) are not different in successful extubation group and failed extubation group. Right DEN in failed extubation group is lower than in successful extubation group. The combined sensitivity and specificity of right DEN<0,48cm for extubation failure was 100% and 60%, respectively. The area under the receiver operating characteristic curve was 0.86 for right DEN. Conclusion: Diaphragmatic ultrasound is not value in predicting mechanically ventilated weaning on all patients. The patient who had right DEN < 0,48 cm were predicted failed extubation, right DEN > 1 cm predicts sucessfull extubation in patients who had strong cough strengh.