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Dynamic inhomogeneity of aeration along the vertical axis of the lung may predict weaning failure regardless of diaphragm dysfunction

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Abstract
Purpose: This study aimed to investigate dynamic changes of lung aeration during a spontaneous breathing trial (SBT) in patients with diaphragm dysfunction (DD) and to predict weaning failure using electrical impedance tomography (EIT). Materials and methods: We enrolled 40 adult patients who received mechanical ventilation over 48 h and were eligible for SBT with a T-piece. All patients were screened for DD using ultrasonography before SBT. EIT data, including global inhomogeneity index (an off-site parameter), and temporal skew of aeration (TSA) (an on-site parameter) were collected. Results: Sixteen (40%) patients had DD. During SBT, the tidal impedance variation decreased by 32% from baseline in patients with DD and by 14% in those without DD (p = 0.001). The global inhomogeneity index in the SBT failure group (n = 9) was 0.92 (median), and that of the SBT success group was 0.65 (p = 0.004). The TSA along the vertical axis of the lung was 12.0% and 2.0%, respectively (p = 0.001). With a vertical TSA cutoff of >= 4.35%, SBT failure was predicted with a sensitivity of 88.9% and specificity of 96.9% (area under the curve: 0.955). Conclusion: Dynamic inhomogeneity of aeration along the vertical axis of the lung as assessed using TSA predicts SBT failure regardless of DD. Trial registration: This trial was retrospectively registered at cris.nih.go.kr (identifier: KCT003567; release date February 27, 2019). (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
Author(s)
고윤석임채만허진원홍상범Do Sik Moon
Issued Date
2021
Type
Article
Keyword
Diaphragmatic dysfunctionElectrical impedance tomographySpontaneous breathing trialUltrasound imagingWeaning
DOI
10.1016/j.jcrc.2021.06.010
URI
http://oak.ulsan.ac.kr/handle/2021.oak/7101
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2548411600&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Dynamic%20inhomogeneity%20of%20aeration%20along%20the%20vertical%20axis%20of%20the%20lung%20may%20predict%20weaning%20failure%20regardless%20of%20diaphragm%20dysfunction&sortby=rank
Publisher
JOURNAL OF CRITICAL CARE
Location
미국
Language
영어
ISSN
0883-9441
Citation Volume
65
Citation Number
0
Citation Start Page
186
Citation End Page
191
Appears in Collections:
Medicine > Medicine
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