Clinical study of shear wave elastography combined with diaphragm thickening fraction and rapid shallow breathing index to predict the outcome of patients with mechanical ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Fangxin ¹ , CHEN Zhaojie ¹ , WANG Zhou ¹ ,  REN Yongfeng ¹ , LI Jian ¹ , YIN Yanhua ¹ , QIAN Beili ²

1. Department of Ultrasound Medicine, Bozhou Hospital Affiliated to Anhui Medical University (Bozhou People's Hospital), Bozhou, Anhui 236800, P. R. China;
2. Intensive Care Unit, Bozhou Hospital Affiliated to Anhui Medical University (Bozhou People's Hospital), Bozhou, Anhui 236800, P. R. China;

Corresponding author：

REN Yongfeng, Email: renyf55507@126.com

Keywords：

Shear wave elastography; diaphragm ultrasound; mechanical ventilation; diaphragm thickening fraction

DOI：

10.7507/1671-6205.202209064

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the application value of shear wave elastography (SWE) combined with diaphragmatic thickening fraction (DTF) and rapid shallow breathing index (RSBI) in predicting the results of weaning of patients with mechanical ventilation. Methods Fifty-two patients with severe illness who were hospitalized in this hospital from January 2022 to September 2022 were treated with mechanical ventilation. After meeting the conditions for weaning, they underwent spontaneous breathing test, and the diaphragm function of patients was evaluated by measuring DTF using ultrasound technology and shear modulus (SM) using SWE technology. According to the weaning results, they were divided into weaning success group and weaning failure group, The differences of mechanical ventilation time, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, respiratory rate, RSBI, oxygenation index, DTF, SM and other parameters between the two groups were compared. Multivariate logistic regression was used to analyze the factors affecting the withdrawal results. The receiver operator characteristic (ROC) curve was used to evaluate the predictive value of potential influencing factors on the withdrawal results. Results There were 39 cases of successful withdrawal and 13 cases of failure. There were significant differences in mechanical ventilation time, respiratory rate, RSBI, DTF and SM between the successful weaning group and the failure group (P<0.05). Through multivariate logistic regression analysis, RSBI [area under the ROC curve (AUC)=0.771, 95% confidence interval (CI) 0.589 - 0.953], DTF (AUC=0.806, 95%CI 0.661 - 0.951), SM (AUC=0.838, 95%CI 0.695 - 0.981) were independent factors that affected the results of withdrawal. The single parameter AUC was smaller than the combined index with RSBI≤70.48 times·min^–1L^–1, DTF≥30.0%, SM≥10.0 kPa as the cutoff value (AUC=0.937, 95%CI 0.714 - 1.0, diagnostic sensitivity, specificity and accuracy were 94.9%, 84.6% and 92.3% respectively). Conclusions SWE technology provides a new quantitative index for evaluating diaphragm function by evaluating diaphragm stiffness. Diaphragm stiffness combined with DTF and RSBI can better predict the successful withdrawal in patients with mechanical ventilation.

Citation： LIU Fangxin, CHEN Zhaojie, WANG Zhou, REN Yongfeng, LI Jian, YIN Yanhua, QIAN Beili. Clinical study of shear wave elastography combined with diaphragm thickening fraction and rapid shallow breathing index to predict the outcome of patients with mechanical ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(1): 38-43. doi: 10.7507/1671-6205.202209064 Copy

1.	Dres M, Demoule A. Diaphragm dysfunction during weaning from mechanical ventilation: an underestimated phenomenon with clinical implications. Crit Care, 2018, 22(1): 73.
2.	Jung B, Moury PH, Mahul M, et al. Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure. Intensive Care Med, 2016, 42(5): 853-861.
3.	Levine S, Nguyen T, Taylor N, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med, 2008, 358(13): 1327-1335.
4.	赵浩天, 燕亚茹, 刘奕, 等. 膈肌和肋间肌增厚率及肋间肌代偿指数评估老年机械通气患者呼吸肌功能. 中国医学影像技术, 2021, 37(9): 1396-1400.
5.	南淑良, 穆靓, 刘莉, 等. 解剖M型超声测定膈肌运动参数预测机械通气患者脱机结果的临床研究. 中国临床医学影像杂志, 2021, 32(9): 616-619.
6.	林宁, 黄秋霞, 张慧珍, 等. 膈肌超声在机械通气患者撤机中的应用. 中国呼吸与危重监护杂志, 2019, 18(4): 339-343.
7.	Fayssoil A, Behin A, Ogna A, et al. Diaphragm: pathophysiology and ultrasound imaging in neuromuscular disorders. J Neuromuscul Dis, 2018, 5(1): 1-10.
8.	Farghaly S, Hasan AA. Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients. Aust Crit Care, 2017, 30(1): 37-43.
9.	Shah AJ, Wai K, Sharron MP, et al. Diaphragmatic thickening fraction by ultrasound in mechanically ventilated pediatric patients: pilot observations during spontaneous breathing trials. J Ultrasound Med, 2022, 41(12): 3043-3050.
10.	Ricoy J, Rodríguez-Núñez N, Álvarez-Dobaño JM, et al. Diaphragmatic dysfunction. Pulmonology, 2019, 25(4): 223-235.
11.	高子瑞, 郭瑞君. 机械通气过程中膈肌改变及膈肌超声应用进展. 中国医学影像技术, 2021, 37(8): 1255-1258.
12.	Ferrari G, De Filippi G, Elia F, et al. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J, 2014, 6(1): 8.
13.	Krieger BP, Isber J, Breitenbucher A, et al. Serial measurements of the rapid-shallow-breathing index as a predictor of weaning outcome in elderly medical patients. Chest, 1997, 112(4): 1029-1034.
14.	Spadaro S, Grasso S, Mauri T, et al. Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index. Crit Care, 2016, 20(1): 305.
15.	马瑛, 叶熊, 宋烨, 等. M型超声膈肌移动度预测机械通气撤机成功的价值. 实用医学杂志, 2020, 36(2): 239-243.
16.	赵浩天, 龙玲, 任珊, 等. 膈肌超声联合呼吸力学指标对ICU老年患者撤机预后评价功能. 中国老年学杂志, 2021, 41(10): 2065-2069.
17.	Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med, 1991, 324(21): 1445-1450.
18.	龙玲, 赵浩天, 任珊, 等. 超声监测膈肌增厚率评价机械通气患者拔管结局. 中国医学影像技术, 2020, 36(4): 540-544.
19.	Zambon M, Greco M, Bocchino S, et al. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intensive Care Med, 2017, 43(1): 29-38.
20.	伍松柏, 戴瑶, 何峻, 等. 超声测量膈肌增厚分数联合膈肌位移在预测机械通气成功撤机中的价值. 实用医学杂志, 2021, 37(12): 1592-1597.
21.	Gursel G, Inci K, Alasgarova Z. Can diaphragm dysfunction be reliably evaluated with pocket-sized ultrasound devices in intensive care unit?. Crit Care Res Pract, 2018, 2018: 5192647.
22.	Cosgrove D, Piscaglia F, Bamber J, et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography. Part 2: Clinical applications. Ultraschall Med, 2013, 34(3): 238-253.
23.	Taljanovic MS, Gimber LH, Becker GW, et al. Shear-wave elastography: basic physics and musculoskeletal applications. Radiographics, 2017, 37(3): 855-870.
24.	Şendur HN, Cerit MN, Şendur AB, et al. Evaluation of diaphragm thickness and stiffness using ultrasound and shear-wave elastography. Ultrasound Q, 2022, 38(1): 89-93.
25.	Xu JH, Wu ZZ, Tao FY, et al. Ultrasound shear wave elastography for evaluation of diaphragm stiffness in patients with stable COPD: a pilot trial. J Ultrasound Med, 2021, 40(12): 2655-2663.
26.	Creze M, Nordez A, Soubeyrand M, et al. Shear wave sonoelastography of skeletal muscle: basic principles, biomechanical concepts, clinical applications, and future perspectives. Skeletal Radiol, 2018, 47(4): 457-471.
27.	Drakonaki E. Ultrasound elastography for imaging tendons and muscles. J Ultrason, 2012, 12(49): 214-225.
28.	Andonian P, Viallon M, Le Goff C, et al. Shear-wave elastography assessments of quadriceps stiffness changes prior to, during and after prolonged exercise: a longitudinal study during an extreme mountain ultra-marathon. PLoS One, 2016, 11(8): e161855.
29.	Aarab Y, Flatres A, Garnier F, et al. Shear wave elastography, a new tool for diaphragmatic qualitative assessment: a translational study. Am J Respir Crit Care Med, 2021, 204(7): 797-806.
30.	Flatres A, Aarab Y, Nougaret S, et al. Real-time shear wave ultrasound elastography: a new tool for the evaluation of diaphragm and limb muscle stiffness in critically ill patients. Critical Care, 2020, 24(1): 34.

1. Dres M, Demoule A. Diaphragm dysfunction during weaning from mechanical ventilation: an underestimated phenomenon with clinical implications. Crit Care, 2018, 22(1): 73.
2. Jung B, Moury PH, Mahul M, et al. Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure. Intensive Care Med, 2016, 42(5): 853-861.
3. Levine S, Nguyen T, Taylor N, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med, 2008, 358(13): 1327-1335.
4. 赵浩天, 燕亚茹, 刘奕, 等. 膈肌和肋间肌增厚率及肋间肌代偿指数评估老年机械通气患者呼吸肌功能. 中国医学影像技术, 2021, 37(9): 1396-1400.
5. 南淑良, 穆靓, 刘莉, 等. 解剖M型超声测定膈肌运动参数预测机械通气患者脱机结果的临床研究. 中国临床医学影像杂志, 2021, 32(9): 616-619.
6. 林宁, 黄秋霞, 张慧珍, 等. 膈肌超声在机械通气患者撤机中的应用. 中国呼吸与危重监护杂志, 2019, 18(4): 339-343.
7. Fayssoil A, Behin A, Ogna A, et al. Diaphragm: pathophysiology and ultrasound imaging in neuromuscular disorders. J Neuromuscul Dis, 2018, 5(1): 1-10.
8. Farghaly S, Hasan AA. Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients. Aust Crit Care, 2017, 30(1): 37-43.
9. Shah AJ, Wai K, Sharron MP, et al. Diaphragmatic thickening fraction by ultrasound in mechanically ventilated pediatric patients: pilot observations during spontaneous breathing trials. J Ultrasound Med, 2022, 41(12): 3043-3050.
10. Ricoy J, Rodríguez-Núñez N, Álvarez-Dobaño JM, et al. Diaphragmatic dysfunction. Pulmonology, 2019, 25(4): 223-235.
11. 高子瑞, 郭瑞君. 机械通气过程中膈肌改变及膈肌超声应用进展. 中国医学影像技术, 2021, 37(8): 1255-1258.
12. Ferrari G, De Filippi G, Elia F, et al. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J, 2014, 6(1): 8.
13. Krieger BP, Isber J, Breitenbucher A, et al. Serial measurements of the rapid-shallow-breathing index as a predictor of weaning outcome in elderly medical patients. Chest, 1997, 112(4): 1029-1034.
14. Spadaro S, Grasso S, Mauri T, et al. Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index. Crit Care, 2016, 20(1): 305.
15. 马瑛, 叶熊, 宋烨, 等. M型超声膈肌移动度预测机械通气撤机成功的价值. 实用医学杂志, 2020, 36(2): 239-243.
16. 赵浩天, 龙玲, 任珊, 等. 膈肌超声联合呼吸力学指标对ICU老年患者撤机预后评价功能. 中国老年学杂志, 2021, 41(10): 2065-2069.
17. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med, 1991, 324(21): 1445-1450.
18. 龙玲, 赵浩天, 任珊, 等. 超声监测膈肌增厚率评价机械通气患者拔管结局. 中国医学影像技术, 2020, 36(4): 540-544.
19. Zambon M, Greco M, Bocchino S, et al. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intensive Care Med, 2017, 43(1): 29-38.
20. 伍松柏, 戴瑶, 何峻, 等. 超声测量膈肌增厚分数联合膈肌位移在预测机械通气成功撤机中的价值. 实用医学杂志, 2021, 37(12): 1592-1597.
21. Gursel G, Inci K, Alasgarova Z. Can diaphragm dysfunction be reliably evaluated with pocket-sized ultrasound devices in intensive care unit?. Crit Care Res Pract, 2018, 2018: 5192647.
22. Cosgrove D, Piscaglia F, Bamber J, et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography. Part 2: Clinical applications. Ultraschall Med, 2013, 34(3): 238-253.
23. Taljanovic MS, Gimber LH, Becker GW, et al. Shear-wave elastography: basic physics and musculoskeletal applications. Radiographics, 2017, 37(3): 855-870.
24. Şendur HN, Cerit MN, Şendur AB, et al. Evaluation of diaphragm thickness and stiffness using ultrasound and shear-wave elastography. Ultrasound Q, 2022, 38(1): 89-93.
25. Xu JH, Wu ZZ, Tao FY, et al. Ultrasound shear wave elastography for evaluation of diaphragm stiffness in patients with stable COPD: a pilot trial. J Ultrasound Med, 2021, 40(12): 2655-2663.
26. Creze M, Nordez A, Soubeyrand M, et al. Shear wave sonoelastography of skeletal muscle: basic principles, biomechanical concepts, clinical applications, and future perspectives. Skeletal Radiol, 2018, 47(4): 457-471.
27. Drakonaki E. Ultrasound elastography for imaging tendons and muscles. J Ultrason, 2012, 12(49): 214-225.
28. Andonian P, Viallon M, Le Goff C, et al. Shear-wave elastography assessments of quadriceps stiffness changes prior to, during and after prolonged exercise: a longitudinal study during an extreme mountain ultra-marathon. PLoS One, 2016, 11(8): e161855.
29. Aarab Y, Flatres A, Garnier F, et al. Shear wave elastography, a new tool for diaphragmatic qualitative assessment: a translational study. Am J Respir Crit Care Med, 2021, 204(7): 797-806.
30. Flatres A, Aarab Y, Nougaret S, et al. Real-time shear wave ultrasound elastography: a new tool for the evaluation of diaphragm and limb muscle stiffness in critically ill patients. Critical Care, 2020, 24(1): 34.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical study of shear wave elastography combined with diaphragm thickening fraction and rapid shallow breathing index to predict the outcome of patients with mechanical ventilation

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content