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| Diaphragm excursion as a predictor of difficult weaning from mechanical ventilation in patients with severe chronic obstructive pulmonary disease |
| XU Shan, BU Zhang, PAN Chun, WANG Jun, FU Jian-Hong, LU Shi-Qi |
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Abstract Objective To evaluate the predictive value of the diaphragm excursion for difficult weaning patients with severe chronic obstructive pulmonary disease（COPD）. Methods One-hundred and two patients with COPD were enrolled for this prospective study. All patients were expected to be weaned when they passed the screening from January 2014 to December 2015. Patients received SBT under PSV for 1 h. At the end of the SBT, the right hemi-diaphragm was visualized in the zone of apposition under B ultrasound probe. The patients who passed the SBT and no need for either reintubation or noninvasive ventilation within 48 hours were included into successful weaning group; the others were included into difficult weaning group. The difficult weaning group were further divided into severe COPD and moderate COPD according to the criterion of the guideline of COPD. Results Of the 102 patients admitted, 62 patients were successful weaning, and 40 patients were difficult weaning. Of the 40 difficult weaning patients, 19 patients were enrolled into severe COPD group, and 21 patients were enrolled into moderate COPD group. There was a significant difference in diaphragm excursion between successful weaning group and difficult weaning group with severe COPD（0.96±0.11 vs. 1.26±0.34，P＜0.05）. It’s AUC to predict difficult weaning for severe COPD patients was 0.819, with a sensitivity of 73.8% and a specificity of 89.5%. Conclusion The assessment of diaphragm excursion using ultrasound may be helpful to predict difficult weaning for patients with severe COPD.
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Received: 30 July 2016
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