Time course of electrical activity of the diaphragm (EAdi) in the peri extubation period and its role as predictor of extubation failure in difficult to wean patients
Por:
Parrilla-Gómez, FJ, Roche-Campo, F, Italiano, S, Parrilla-Gómez, A, Morán, I, Mancebo, J, Maraffi, T
Publicada:
17 sep 2024
Resumen:
Introduction Weaning patients from mechanical ventilation is crucial in the management of acute respiratory failure (ARF). Spontaneous breathing trials (SBT) are used to assess readiness for extubation, but extubation failure remains a challenge. Diaphragmatic function, measured by electrical activity of the diaphragm (EAdi), may provide insights into weaning outcomes. Materials and methods This prospective, observational study included difficult-to-wean patients undergoing invasive mechanical ventilation. EAdi was recorded before, during, and after extubation. Patients were categorized into extubation success and failure groups based on reintubation within 48 h. Statistical analysis assessed EAdi patterns and predictive value. Results Thirty-one patients were analyzed, with six experiencing extubation failure. Overall, EAdi increased significantly between the phases before the SBT, the SBT and post-extubation period, up to 24 h (p < 0.001). EAdi values were higher in the extubation failure group during SBT (p = 0.01). An EAdi > 30 mu V during SBT predicted extubation failure with 92% sensitivity and 67% specificity. Multivariable analysis confirmed EAdi as an independent predictor of extubation failure. Conclusions In difficult-to-wean patients, EAdi increases significantly between the phases before the SBT, the SBT and post-extubation period and is significantly higher in patients experiencing extubation failure. An EAdi > 30 mu V during SBT may enhance extubation failure prediction compared to conventional parameters. Advanced monitoring of diaphragmatic function could improve weaning outcomes in critical care settings.
Filiaciones:
Parrilla-Gómez, FJ:
Hosp del Mar Barcelona, Crit Care Dept, Barcelona, Spain
UPF, Dept Med & Life Sci MELIS, Barcelona, Spain
Hosp del Mar Res Inst IMIM, Crit Illness Res Grp GREPAC, Barcelona, Spain
Roche-Campo, F:
Hosp Verge Cinta Tortosa, Crit Care Dept, Tarragona, Spain
Pere Virgili Inst Hlth Res IISPV, Tarragona, Spain
Italiano, S:
Hosp Clin Barcelona, Anesthesiol Resuscitat & Pain Management Serv, Barcelona, Spain
Parrilla-Gómez, A:
Hosp del Mar Res Inst IMIM, Crit Illness Res Grp GREPAC, Barcelona, Spain
Morán, I:
Univ Autonoma Barcelona UAB, Hosp Santa Creu & St Pau, Intens Care Unit, Barcelona, Spain
Mancebo, J:
Univ Autonoma Barcelona UAB, Hosp Santa Creu & St Pau, Intens Care Unit, Barcelona, Spain
Maraffi, T:
Hop Intercommunal Creteil, Serv Reanimat, 40 Ave Verdun, F-94000 Creteil, France
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