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：

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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.	趙浩天, 燕亞茹, 劉奕, 等. 膈肌和肋間肌增厚率及肋間肌代償指數評估老年機械通氣患者呼吸肌功能. 中國醫學影像技術, 2021, 37(9): 1396-1400.
5.	南淑良, 穆靚, 劉莉, 等. 解剖M型超聲測定膈肌運動參數預測機械通氣患者脫機結果的臨床研究. 中國臨床醫學影像雜志, 2021, 32(9): 616-619.
6.	林寧, 黃秋霞, 張慧珍, 等. 膈肌超聲在機械通氣患者撤機中的應用. 中國呼吸與危重監護雜志, 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-Nú?ez N, álvarez-Doba?o JM, et al. Diaphragmatic dysfunction. Pulmonology, 2019, 25(4): 223-235.
11.	高子瑞, 郭瑞君. 機械通氣過程中膈肌改變及膈肌超聲應用進展. 中國醫學影像技術, 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.	馬瑛, 葉熊, 宋燁, 等. M型超聲膈肌移動度預測機械通氣撤機成功的價值. 實用醫學雜志, 2020, 36(2): 239-243.
16.	趙浩天, 龍玲, 任珊, 等. 膈肌超聲聯合呼吸力學指標對ICU老年患者撤機預后評價功能. 中國老年學雜志, 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.	龍玲, 趙浩天, 任珊, 等. 超聲監測膈肌增厚率評價機械通氣患者拔管結局. 中國醫學影像技術, 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, 戴瑤, 何峻, 等. 超聲測量膈肌增厚分數聯合膈肌位移在預測機械通氣成功撤機中的價值. 實用醫學雜志, 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.	?endur HN, Cerit MN, ?endur 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. 趙浩天, 燕亞茹, 劉奕, 等. 膈肌和肋間肌增厚率及肋間肌代償指數評估老年機械通氣患者呼吸肌功能. 中國醫學影像技術, 2021, 37(9): 1396-1400.
5. 南淑良, 穆靚, 劉莉, 等. 解剖M型超聲測定膈肌運動參數預測機械通氣患者脫機結果的臨床研究. 中國臨床醫學影像雜志, 2021, 32(9): 616-619.
6. 林寧, 黃秋霞, 張慧珍, 等. 膈肌超聲在機械通氣患者撤機中的應用. 中國呼吸與危重監護雜志, 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-Nú?ez N, álvarez-Doba?o JM, et al. Diaphragmatic dysfunction. Pulmonology, 2019, 25(4): 223-235.
11. 高子瑞, 郭瑞君. 機械通氣過程中膈肌改變及膈肌超聲應用進展. 中國醫學影像技術, 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. 馬瑛, 葉熊, 宋燁, 等. M型超聲膈肌移動度預測機械通氣撤機成功的價值. 實用醫學雜志, 2020, 36(2): 239-243.
16. 趙浩天, 龍玲, 任珊, 等. 膈肌超聲聯合呼吸力學指標對ICU老年患者撤機預后評價功能. 中國老年學雜志, 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. 龍玲, 趙浩天, 任珊, 等. 超聲監測膈肌增厚率評價機械通氣患者拔管結局. 中國醫學影像技術, 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, 戴瑤, 何峻, 等. 超聲測量膈肌增厚分數聯合膈肌位移在預測機械通氣成功撤機中的價值. 實用醫學雜志, 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. ?endur HN, Cerit MN, ?endur 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

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